Provider Demographics
NPI:1003790866
Name:NEWLIN, SHANIA GRACE
Entity type:Individual
Prefix:
First Name:SHANIA
Middle Name:GRACE
Last Name:NEWLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448-1652
Mailing Address - Country:US
Mailing Address - Phone:618-783-7529
Mailing Address - Fax:
Practice Address - Street 1:600 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1652
Practice Address - Country:US
Practice Address - Phone:618-783-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1101824106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician