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Provider Information for 1912431560


The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.

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SHANNON KELEHER


Sex: Female

NPI: 1912431560
Last Updated: 2019-02-07
Certification Date:

Details

NameValue
NPI1912431560
Enumeration Date2017-04-19
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address 155 N MICHIGAN AVE STE 209
CHICAGO, IL 60601-7940
United States

Phone: 312-729-5258 | Fax:
 
Primary Practice Address 155 N MICHIGAN AVE STE 209
CHICAGO, IL 60601
United States

Phone: 312-729-5258 | Fax:
 
Secondary Practice Address(es)

1631 S MICHIGAN AVE
APT 501
CHICAGO, IL 60616-1258
United States

Phone: 847-722-6296 | Fax:
 

Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 104100000X - Social Worker IL150.101233