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NPI Code Detail

MEDICARE: MRS. SUSAN ELAINE SHELTON LCSW, DCSW, BCD

MEDICARE: MRS. SUSAN ELAINE SHELTON LCSW, DCSW, BCD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1053412296
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN ELAINE SHELTON LCSW, DCSW, BCD
Provider Business Mailing Address
First Line : 16612 WILLIAMS CHAPEL RD
Second Line :
City : EWING
State : IL
Zip : 62836-1049
Country : US
Telephone Number : 618-629-2124
Fax Number :
Provider Business Practice Location Address
First Line : 2401 W MAIN ST
Second Line :
City : MARION
State : IL
Zip : 62959-1188
Country : US
Telephone Number : 618-997-5311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. SUSAN ELAINE SHELTON LCSW, DCSW, BCD” Practice Location

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