MEDICARE: SHEA NELSON

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1215804927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEA NELSON

Provider Business Mailing Address
First Line	:	2924 W MEDILL AVE APT 314
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-0688
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 N LINCOLN AVE
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-3923
Country	:	US
Telephone Number	:	630-465-3963
Fax Number	:

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

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	10/20/2025

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Directions to “ SHEA NELSON ” Practice Location

Language	Start Address	Practice Location

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