MEDICARE: MS. SARAH KATHLEEN SHIMMEL LPC

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	101YP2500X	Professional Counselor	178.006717	IL
2	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	178.006717	OTHER	IL	LICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1518257997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH KATHLEEN SHIMMEL LPC

Provider Business Mailing Address
First Line	:	3511 N RACINE AVE
Second Line	:	APT. 2E
City	:	CHICAGO
State	:	IL
Zip	:	60657-1525
Country	:	US
Telephone Number	:	203-273-1815
Fax Number	:

Provider Business Practice Location Address
First Line	:	3712 N BROADWAY ST
Second Line	:	STE. 250
City	:	CHICAGO
State	:	IL
Zip	:	60613-4235
Country	:	US
Telephone Number	:	773-615-3202
Fax Number	:

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

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	04/19/2011

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