Provider Information for 1316545429
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SHANTIA D MORGAN LPC
Sex: Female
NPI: 1316545429
Last Updated: 2020-10-12
Certification Date: 2020-10-12
Certification Date: 2020-10-12
Details
| Name | Value | ||||||||||||||||||||||||||||
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| NPI | 1316545429 | ||||||||||||||||||||||||||||
| Enumeration Date | 2020-10-12 | ||||||||||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||||||||||||||
| Status | Active | ||||||||||||||||||||||||||||
| Mailing Address | 2409 N CLYBOURN AVE CHICAGO, IL 60614-6185 United States Phone: | Fax: | ||||||||||||||||||||||||||||
| Primary Practice Address | 2409 N CLYBOURN AVE CHICAGO, IL 60614 United States Phone: 773-755-1775 | Fax: | ||||||||||||||||||||||||||||
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