Healthcare Provider Details

I. General information

NPI: 1265440671
Provider Name (Legal Business Name): SHEILA SENN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/04/2020
Certification Date: 07/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CARY ST
CARY IL
60013-2706
US

IV. Provider business mailing address

468 ROCKLAND RD
CRYSTAL LAKE IL
60014-4120
US

V. Phone/Fax

Practice location:
  • Phone: 815-687-6955
  • Fax:
Mailing address:
  • Phone: 815-687-6955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-005067
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: