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NPI Code Detail

MEDICARE: MRS. DAWN L THIELEMANN-SHIELDS MA, LCPC

MEDICARE: MRS. DAWN L THIELEMANN-SHIELDS MA, LCPC
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
1101YP2500XProfessional Counselor180012571IL
2101YM0800XMental Health Counselor178.006325IL

General Provider Information

NPI Number : 1114240108
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DAWN L THIELEMANN-SHIELDS MA, LCPC
Provider Business Mailing Address
First Line : 13 FAIRLANE DR
Second Line :
City : JOLIET
State : IL
Zip : 60435-6483
Country : US
Telephone Number : 815-730-8900
Fax Number : 815-730-0988
Provider Business Practice Location Address
First Line : 13 FAIRLANE DR
Second Line :
City : JOLIET
State : IL
Zip : 60435-6483
Country : US
Telephone Number : 815-730-8900
Fax Number : 815-730-0988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2010
Last Update Date : 05/09/2022

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