Healthcare Provider Details

I. General information

NPI: 1265342539
Provider Name (Legal Business Name): SHANNON RENE BOENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E DEYOUNG ST STE B
MARION IL
62959-3143
US

IV. Provider business mailing address

101 E DEYOUNG ST STE B
MARION IL
62959-3143
US

V. Phone/Fax

Practice location:
  • Phone: 618-693-9139
  • Fax:
Mailing address:
  • Phone: 618-693-9139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: