Healthcare Provider Details

I. General information

NPI: 1548838063
Provider Name (Legal Business Name): SHADEN GONZALEZ MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7357 NORTH AVE
RIVER FOREST IL
60305-1230
US

IV. Provider business mailing address

7357 NORTH AVE
RIVER FOREST IL
60305-1230
US

V. Phone/Fax

Practice location:
  • Phone: 773-270-0469
  • Fax:
Mailing address:
  • Phone: 773-270-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.020901
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: