Healthcare Provider Details

I. General information

NPI: 1306433503
Provider Name (Legal Business Name): PNEURISSA SHANIQUE STAMPS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 08/19/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N MICHIGAN AVE STE 9012
CHICAGO IL
60601-7713
US

IV. Provider business mailing address

6001 S VERNON AVE APT 905
CHICAGO IL
60637-2381
US

V. Phone/Fax

Practice location:
  • Phone: 331-240-0044
  • Fax:
Mailing address:
  • Phone: 312-504-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180016304
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: