Healthcare Provider Details

I. General information

NPI: 1184531055
Provider Name (Legal Business Name): SHEENA K MATHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 EUCLID AVE STE 104
ROLLING MEADOWS IL
60008-2083
US

IV. Provider business mailing address

609 E BAUER RD
NAPERVILLE IL
60563-2819
US

V. Phone/Fax

Practice location:
  • Phone: 847-917-9974
  • Fax:
Mailing address:
  • Phone: 847-778-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.032986
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: