MEDICARE: SHEADE PSYCHOTHERAPY PLLC

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	1041C0700X	Clinical Social Worker
2	101YP2500X	Professional Counselor	180009684	IL
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1952780264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEADE PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	4411 N RAVENSWOOD AVE STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5802
Country	:	US
Telephone Number	:	773-999-9987
Fax Number	:	847-780-3360

Provider Business Practice Location Address
First Line	:	4411 N RAVENSWOOD AVE STE 200
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5802
Country	:	US
Telephone Number	:	773-999-9987
Fax Number	:	847-868-8614

Authorized Official
Title or Position	:	OWNER, PSYCHOTHERAPIST
Name	:	ALLISON K. SHEADE
Credential	:	LCPC
Telephone Number	:	773-999-9987

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	04/24/2026

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