Healthcare Provider Details

I. General information

NPI: 1952861023
Provider Name (Legal Business Name): SHELBY OLITA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W LAKE ST
ELMHURST IL
60126-1419
US

IV. Provider business mailing address

11 W BIRCHWOOD AVE
HINSDALE IL
60521-2804
US

V. Phone/Fax

Practice location:
  • Phone: 331-209-0047
  • Fax:
Mailing address:
  • Phone: 630-853-3374
  • Fax: 630-789-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149027175
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: