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NPI Code Detail

MEDICARE: DR. SHANNON LEIGH CALVERT OSUCHOWSKI PSY.D.

MEDICARE: DR. SHANNON LEIGH CALVERT OSUCHOWSKI PSY.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
1103TC0700XClinical Psychologist071008716IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1071008716OTHERILILLINOIS DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION

General Provider Information

NPI Number : 1811245269
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON LEIGH CALVERT OSUCHOWSKI PSY.D.
Provider Business Mailing Address
First Line : 2948 ARTESIAN RD STE 112
Second Line :
City : NAPERVILLE
State : IL
Zip : 60564-8559
Country : US
Telephone Number : 630-428-7890
Fax Number :
Provider Business Practice Location Address
First Line : 2948 ARTESIAN RD STE 112
Second Line :
City : NAPERVILLE
State : IL
Zip : 60564-8559
Country : US
Telephone Number : 630-428-7890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2012
Last Update Date : 10/31/2014

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