Healthcare Provider Details

I. General information

NPI: 1811245269
Provider Name (Legal Business Name): SHANNON LEIGH CALVERT OSUCHOWSKI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON LEIGH CALVERT PSYD

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2948 ARTESIAN RD STE 112
NAPERVILLE IL
60564-8559
US

IV. Provider business mailing address

2948 ARTESIAN RD STE 112
NAPERVILLE IL
60564-8559
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-7890
  • Fax:
Mailing address:
  • Phone: 630-428-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071008716
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: