Individual
MELISSA A SHANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
3020 W. WILLOW KNOLLS DRIVE, PEORIA, IL 61614-1002
(309) 681-5850
(309) 681-5658
Mailing address
3020 W. WILLOW KNOLLS DRIVE, PEORIA, IL 61614-1002
(309) 681-5850
(309) 681-5658
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180008837
IL
Other
Enumeration date
10/28/2013
Last updated
10/28/2013
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