MEDICARE: MS. SHENANDOAH CARDWELL MA, NCC, 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
1	101Y00000X	Counselor	NCC CERT # 22818
2	101YP2500X	Professional Counselor	2906-125	WI
3	101YP2500X	Professional Counselor		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	169887	OTHER	IL	MHN PROVIDER #

General Provider Information

NPI Number	:	1710098611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHENANDOAH CARDWELL MA, NCC, LCPC

Provider Business Mailing Address
First Line	:	34930 N US HIGHWAY 45
Second Line	:	SUITE 101
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-7537
Country	:	US
Telephone Number	:	847-543-7755
Fax Number	:	847-543-7759

Provider Business Practice Location Address
First Line	:	34930 N US HIGHWAY 45
Second Line	:	SUITE 101
City	:	LAKE VILLA
State	:	IL
Zip	:	60046-7537
Country	:	US
Telephone Number	:	847-543-7755
Fax Number	:	847-543-7759

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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