Individual
BRIANNA SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
61 WOODSIDE RD, RIVERSIDE, IL 60546-1974
(217) 416-5393
Mailing address
850 S CLARK ST UNIT 611, CHICAGO, IL 60605-1778
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
2382225
IL
Other
Enumeration date
08/28/2018
Last updated
08/28/2018
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