Healthcare Provider Details

I. General information

NPI: 1205488301
Provider Name (Legal Business Name): WILLIAM SHAWN SINGERMAN MED., MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W JACKSON BLVD STE 1028
CHICAGO IL
60604-3648
US

IV. Provider business mailing address

126 E CHESTNUT ST
CHICAGO IL
60611-2014
US

V. Phone/Fax

Practice location:
  • Phone: 312-505-2751
  • Fax:
Mailing address:
  • Phone: 312-505-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.015071
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: