Healthcare Provider Details

I. General information

NPI: 1639510167
Provider Name (Legal Business Name): DR. SHANTELLE AND ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 05/25/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 S WASHINGTON ST STE 115
NAPERVILLE IL
60540-6669
US

IV. Provider business mailing address

552 S WASHINGTON ST STE 115
NAPERVILLE IL
60540-6669
US

V. Phone/Fax

Practice location:
  • Phone: 312-339-9832
  • Fax: 331-999-3971
Mailing address:
  • Phone: 312-339-9832
  • Fax: 630-857-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANTELLE WHITEHEAD
Title or Position: OWNER
Credential: PSYD
Phone: 312-339-9832