Healthcare Provider Details

I. General information

NPI: 1346111622
Provider Name (Legal Business Name): QIUCHEN SHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAE SHEN LPC

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 424
CHICAGO IL
60602-3844
US

IV. Provider business mailing address

1121 CHURCH ST APT 309
EVANSTON IL
60201-3634
US

V. Phone/Fax

Practice location:
  • Phone: 872-274-4344
  • Fax: 866-671-9991
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.022040
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: