Healthcare Provider Details

I. General information

NPI: 1689792822
Provider Name (Legal Business Name): SHINING STAR THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 S ROUTE 59 SUITE# 116-326
PLAINFIELD IL
60585-5696
US

IV. Provider business mailing address

13400 S ROUTE 59 STE 116-326
PLAINFIELD IL
60585-5696
US

V. Phone/Fax

Practice location:
  • Phone: 815-267-7334
  • Fax: 630-429-9411
Mailing address:
  • Phone: 815-267-7334
  • Fax: 630-429-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.005672
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.004828
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070.016938
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.004242
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9932502
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerBCBS OF IL

VIII. Authorized Official

Name: MYLENE CORMIER
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 815-267-7334