Provider Demographics
NPI:1447453683
Name:WEEDEN SHANNON, C'RAI
Entity type:Individual
Prefix:MS
First Name:C'RAI
Middle Name:
Last Name:WEEDEN SHANNON
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 1:656 PEARSON ST
Mailing Address - Street 2:#210
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4629
Mailing Address - Country:US
Mailing Address - Phone:773-633-9100
Mailing Address - Fax:
Practice Address - Street 1:2901 FINLEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1041
Practice Address - Country:US
Practice Address - Phone:630-495-6800
Practice Address - Fax:630-495-8200
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCS79720307P222Q00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist