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General NPI Number Information
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NPI Number | 1356052096
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Entity Type | Individual
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Provider Name | SHEILA BRADY DALTON
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Gender | Female
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 5151 MOCHEL DR STE 304
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5078
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Country | US
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Telephone | 630-324-4663
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Fax | 630-395-9974
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Provider Business Mailing Address
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Address Line | 415 E NORTH WATER ST APT 804W
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City | CHICAGO
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State | IL
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Zip | 60611-5810
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Country | US
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Telephone |
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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 | 180.014836
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License Number State | IL
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