Healthcare Provider Details

I. General information

NPI: 1952846768
Provider Name (Legal Business Name): SHANNON MARY HILL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 FOXFIELD RD STE 307
ST CHARLES IL
60174-5799
US

IV. Provider business mailing address

2900 FOXFIELD RD STE 307
ST CHARLES IL
60174-5799
US

V. Phone/Fax

Practice location:
  • Phone: 630-208-3200
  • Fax: 630-208-3201
Mailing address:
  • Phone: 630-208-3200
  • Fax: 630-208-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.021605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: