Shannon Marie Balaban, PHD
Individual provider Active NPI Clinical Psychologist · Phoenix, AZ
NPI 1093425985 · NPPES record last updated Mar 4, 2025
Key facts
- NPI
- 1093425985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY-005745 (AZ)
- Practice address
- 9327 N 3Rd St Ste 200
Phoenix, AZ 85020-2473 - Phone
- (520) 595-5500
- NPI assigned
- Dec 1, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Ganesha Institute of Neurology and Psychiatry SC
Practice addresses (Care Compare)
101 N Colorado St
Chandler, AZ 85225-5534
Phone (847) 816-6335
1860 W Winchester Rd
Suite 106
Libertyville, IL 60048-5312
Phone (847) 816-6335
4600 Green Bay Rd
Kenosha, WI 53144-1719
Phone (847) 816-6335
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in AZ, IL, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240430004345 | AZ | Practitioner - Clinical Psychologist | 3072953520 | Reassigns benefits to 1 organization |
| I20240513003639 | IL | Practitioner - Clinical Psychologist | 3072953520 | Reassigns benefits to 1 organization |
| I20240515003012 | WI | Practitioner - Clinical Psychologist | 3072953520 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-005745 | AZ | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ganesha Institute of Neurology and Psychiatry SC | Current |
Accepting new patients | |
| Ganesha Institute of Neurology and Psychiatry SC | Current |
Accepting new patients | |
| Ganesha Institute of Neurology and Psychiatry SC | Current |
Accepting new patients |
Locations
9327 N 3rd St
Ste 200
Phoenix, AZ 85020
Phone (520) 595-5500
1860 W Winchester Rd
Libertyville, IL 60048
Phone (847) 573-9486
1850 W Winchester Rd
Ste 115
Libertyville, IL 60048
Phone (847) 816-6335
1860 W Winchester Rd
Ste 106
Libertyville, IL 60048
Phone (847) 599-0715
4600 Green Bay Rd
Kenosha, WI 53144
Phone (847) 816-6335
Interoperability endpoints
- shannon.balaban.1@9664.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY-005745 | AZ | Yes |
Addresses
Primary practice location
9327 N 3Rd St Ste 200
Phoenix, AZ 85020-2473
Mailing address
9327 N 3Rd St Ste 200
Phoenix, AZ 85020-2473
Phone (520) 595-5500
Other practice location 1
1860 W Winchester Rd Ste 106
Libertyville, IL 60048-5312
Phone (847) 816-6335
Other practice location 2
4600 Green Bay Rd
Kenosha, WI 53144-1719
Phone (262) 286-1860
Other providers in Phoenix, AZ
- Audrey Lucille Bakken
- Alex Patrick Bakowski
- Heatherann Alison Bal
- Nazim Bal
- Natasha Sarosh Bala
- Diya Balachandran
- Anupama Balaji
- Sudha Balan
- Balanced Health Medical Center
- Balanced Life Psychiatry
All providers in Phoenix, AZ · Clinical Psychologist in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.