Active NPI
Shannon M Flynn, MA, LCPC
- Professional Counselor
- Shorewood, IL
National Provider Identifier
1891075149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 180012013
- Practice address
- 1111 Ravinia CT
Shorewood, IL 60404-9444 - Phone
- (815) 585-1019
- NPI assigned
- Aug 18, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 279884 | LA | |
| Professional Counselor | 101YP2500X | 180012013 | IL | Primary |
Addresses
Primary practice location
1111 Ravinia CT
Shorewood, IL 60404-9444
Mailing address
1111 Ravinia CT
Shorewood, IL 60404-9444
Phone (815) 585-1019
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180012013 | Other | IL | ILLINOIS LCPC LICENSE NUMBER |
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 279884 | LA | MD | Counselor |
| 180012013 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1313625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630454400000",
"number": "1891075149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 RAVINIA CT",
"city": "SHOREWOOD",
"state": "IL",
"postal_code": "604049444",
"telephone_number": "815-585-1019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 RAVINIA CT",
"city": "SHOREWOOD",
"state": "IL",
"postal_code": "604049444",
"telephone_number": "815-585-1019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLYNN",
"first_name": "SHANNON",
"middle_name": "M",
"credential": "MA, LCPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-08-18",
"last_updated": "2021-09-01",
"certification_date": "2021-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "LA",
"license": "279884",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "180012013",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLINOIS LCPC LICENSE NUMBER",
"identifier": "180012013",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shorewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.