Healthcare Provider Details

I. General information

NPI: 1417575408
Provider Name (Legal Business Name): DANIELLE SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 MOCHEL DR STE 304
DOWNERS GROVE IL
60515-5078
US

IV. Provider business mailing address

262 E SAINT CHARLES RD
CAROL STREAM IL
60188-3527
US

V. Phone/Fax

Practice location:
  • Phone: 630-324-4663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.018815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: