Healthcare Provider Details

I. General information

NPI: 1669318812
Provider Name (Legal Business Name): HEATHER SHAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 1ST ST
HIGHLAND PARK IL
60035-3202
US

IV. Provider business mailing address

18175 W TWIN LAKES BLVD
GRAYSLAKE IL
60030-2044
US

V. Phone/Fax

Practice location:
  • Phone: 847-433-1303
  • Fax:
Mailing address:
  • Phone: 847-201-7066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180016089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: