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1245520246 NPI number — ELIZABETH COLLEEN STILES-SHIELDS PH.D.

NPI Number: 1245520246
Health Care Provider/Practitioner: ELIZABETH COLLEEN STILES-SHIELDS PH.D.

Information about “1245520246” NPI (ELIZABETH COLLEEN STILES-SHIELDS PH.D.) exists in 1245520246 in HTML format HTML  |  1245520246 in plain Text format TXT  |  1245520246 in PDF (Portable Document Format) PDF  |  1245520246 in an XML format XML  formats.

NPI Number : 1245520246 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245520246",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "STILES-SHIELDS",
    "FirstName": "ELIZABETH",
    "MiddleName": "COLLEEN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "STILES-SHIELDS",
    "OtherFirstName": "COLLEEN",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PH.D.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1700 W VAN BUREN ST STE 5827B",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60612-5500",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "312-563-9012",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1747 W ROOSEVELT RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60608-1264",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-413-1128",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/11/2011",
    "LastUpdateDate": "10/03/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "149.014597",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103TC0700X",
          "TaxonomyName": "Clinical Psychologist",
          "LicenseNumber": "071.009980",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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