=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093310286
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON DALY MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2020
-----------------------------------------------------
Last Update Date | 02/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 DUNHAM RD STE 2A
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60174-1498
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-926-5987
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 323 N COLLEGE ST
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60510-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-926-5987
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149.010596
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------