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General NPI Number Information
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NPI Number | 1073885521
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Entity Type | Individual
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Provider Name | SHANNON GERTRUDE BARLOW LCPC
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Gender | Female
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 5 REVERE DR STE 234
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City | NORTHBROOK
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State | IL
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Zip | 60062-1566
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Country | US
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Telephone | 773-259-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 360 WOODLAND RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-5055
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Country | US
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Telephone | 773-259-4200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1800007786
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.007786
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License Number State | IL
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