Active NPI
Shannon Ellison, MED
- Developmental Therapist
- Country Club Hills, IL
National Provider Identifier
1255815791
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- Practice address
- 3818 169TH St
Country Club Hills, IL 60478-2138 - Phone
- (317) 413-4275
- NPI assigned
- Sep 20, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | Primary |
Addresses
Primary practice location
3818 169TH St
Country Club Hills, IL 60478-2138
Mailing address
3818 169TH St
Country Club Hills, IL 60478-2138
Phone (317) 413-4275
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537401600000",
"number": "1255815791",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3818 169TH ST",
"city": "COUNTRY CLUB HILLS",
"state": "IL",
"postal_code": "604782138",
"telephone_number": "317-413-4275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3818 169TH ST",
"city": "COUNTRY CLUB HILLS",
"state": "IL",
"postal_code": "604782138",
"telephone_number": "317-413-4275"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLISON",
"first_name": "SHANNON",
"credential": "MED",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-20",
"last_updated": "2018-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Country Club Hills, IL
- Reginald Washington Edwards, LCSW
- Ehis Transportation Inc
- Elevate Care Country Club Hills LLC (Elevate Care Country Club Hills)
- Elevate Care Country Club Hills LLC (Elevate Care Country Club Hills)
- Elevated Excellence
- Faith Community Health Services, Inc
- Firsteclipse Medical Services Inc.
- Foatex Health Inc
- For the Love of You Counseling LLC
- Friends and Family Home Healthcare Agency
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.