Healthcare Provider Details

I. General information

NPI: 1427962885
Provider Name (Legal Business Name): SHANNON GOOLD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 E OGDEN AVE
LA GRANGE IL
60525-3137
US

IV. Provider business mailing address

1537 PORTSMOUTH AVE
WESTCHESTER IL
60154-3622
US

V. Phone/Fax

Practice location:
  • Phone: 708-354-0858
  • Fax:
Mailing address:
  • Phone: 703-868-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149015890
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: