Provider Demographics
NPI:1871074930
Name:SHEA, KATHLEEN M (LCPC, CADC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:M
Last Name:SHEA
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2836
Mailing Address - Country:US
Mailing Address - Phone:815-431-8206
Mailing Address - Fax:
Practice Address - Street 1:417 W MADISON ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2836
Practice Address - Country:US
Practice Address - Phone:815-431-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.002890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1154538510OtherLCPC, CADC