Individual provider Active NPI

Shauntai P Taylor

  • Counselor
  • Naperville, IL
National Provider Identifier
1093589699
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
178.019459 Issued in IL
Practice address
2948 Artesian Rd Ste 112
Naperville, IL 60564-8559
Phone
(630) 428-7890
Fax
(630) 428-7891
NPI assigned
Nov 14, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 178.019459 IL Primary

Addresses

Primary practice location

2948 Artesian Rd Ste 112
Naperville, IL 60564-8559

Mailing address

1333 S Wabash Ave Unit 1711
Chicago, IL 60605-2628
Phone (312) 796-1315

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240113000727 IL Practitioner - Mental Health Counselor 7719339837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

1 E Erie St
Suite 520
Chicago, IL 60611-2792
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
178.019459ILMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. PastSince Nov 19, 2023 Accepting new patients
Psychology Specialists LTD Counselor Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1699920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1093589699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 S WABASH AVE UNIT 1711",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052628",
            "telephone_number": "312-796-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2948 ARTESIAN RD STE 112",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605648559",
            "telephone_number": "630-428-7890",
            "fax_number": "630-428-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "SHAUNTAI",
        "middle_name": "P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-14",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "IL",
            "license": "178.019459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

Verify at the official NPI Registry.