MEDICARE: DR. STEWART AARON SHANKMAN PH.D.

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
1	103TB0200X	Cognitive & Behavioral Psychologist		IL
2	103TC0700X	Clinical Psychologist		IL

General Provider Information

NPI Number	:	1114106697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEWART AARON SHANKMAN PH.D.

Provider Business Mailing Address
First Line	:	1007 W HARRISON ST RM 1062D
Second Line	:	M/C 285
City	:	CHICAGO
State	:	IL
Zip	:	60607-7135
Country	:	US
Telephone Number	:	312-355-3812
Fax Number	:	312-413-4122

Provider Business Practice Location Address
First Line	:	1007 W HARRISON ST RM 1062D
Second Line	:	M/C 285
City	:	CHICAGO
State	:	IL
Zip	:	60607-7135
Country	:	US
Telephone Number	:	312-355-3812
Fax Number	:	312-413-4122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	10/31/2007

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