Healthcare Provider Details

I. General information

NPI: 1043886674
Provider Name (Legal Business Name): LUBOWA N SHIMONDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 W CHARIOT CT APT 1B
MOUNT PROSPECT IL
60056-5533
US

IV. Provider business mailing address

1705 W CHARIOT CT APT 1B
MOUNT PROSPECT IL
60056-5533
US

V. Phone/Fax

Practice location:
  • Phone: 224-762-9823
  • Fax:
Mailing address:
  • Phone: 224-762-9823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: