Active NPI
Leslie K Shan, MS
- Mental Health Counselor
- Lawrenceville, IL
National Provider Identifier
1578018172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 11020 State Route 250
Lawrenceville, IL 62439 - Phone
- (618) 943-3754
- Fax
- (618) 943-3657
- NPI assigned
- Aug 24, 2016
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IL | Primary |
Addresses
Primary practice location
11020 State Route 250
Lawrenceville, IL 62439
Mailing address
11020 State Route 250
PO Box 516
Lawrenceville, IL 62439
Phone (618) 943-3754
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 376003178 (008) | Medicaid | IL |
Other names 1
- Leslie K Allard
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 Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471996800000",
"number": "1578018172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11020 STATE ROUTE 250",
"address_2": "PO BOX 516",
"city": "LAWRENCEVILLE",
"state": "IL",
"postal_code": "62439",
"telephone_number": "618-943-3754",
"fax_number": "618-943-3657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11020 STATE ROUTE 250",
"city": "LAWRENCEVILLE",
"state": "IL",
"postal_code": "62439",
"telephone_number": "618-943-3754",
"fax_number": "618-943-3657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAN",
"first_name": "LESLIE",
"middle_name": "K",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-24",
"last_updated": "2016-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "376003178 (008)",
"state": "IL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "LESLIE",
"last_name": "ALLARD",
"middle_name": "K",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lawrenceville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.