Healthcare Provider Details

I. General information

NPI: 1699135442
Provider Name (Legal Business Name): SHANNON GRIFFITH B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BEECH ST BLDG 8-1
NORMAL IL
61761-1560
US

IV. Provider business mailing address

1455 COUNTY ROAD 200 N
GOODFIELD IL
61742-7504
US

V. Phone/Fax

Practice location:
  • Phone: 708-517-0396
  • Fax:
Mailing address:
  • Phone: 708-517-0396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180012666
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: