Individual
MS. AMY J SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
15300 WEST AVE STE 313, PALOS HEIGHTS, IL 60463
(708) 923-7878
(708) 923-7888
Mailing address
15300 WEST AVE STE 313, PALOS HEIGHTS, IL 60463
(708) 923-7878
(708) 923-7888
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
149.010542
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
349643415001
—
IL
01
—
F400104844
MEDICARE PTAN
IL
Enumeration date
06/11/2007
Last updated
12/08/2021
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