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General NPI Number Information
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NPI Number | 1306852835
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Entity Type | Individual
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Provider Name | TIM SHEA L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 507 W SPRINGFIELD AVE
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City | URBANA
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State | IL
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Zip | 61801-3108
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Country | US
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Telephone | 217-649-9076
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Fax | 217-344-4733
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Provider Business Mailing Address
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Address Line | 507 W SPRINGFIELD AVE
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City | URBANA
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State | IL
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Zip | 61801-3108
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Country | US
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Telephone | 217-649-9076
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Fax | 217-344-4733
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | IL
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