Provider Demographics
NPI:1871729301
Name:FLEMING, SHANNON
Entity type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:
Last Name:FLEMING
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 1:532 W ROSCOE ST
Mailing Address - Street 2:470
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3505
Mailing Address - Country:US
Mailing Address - Phone:773-661-1874
Mailing Address - Fax:
Practice Address - Street 1:532 W ROSCOE ST
Practice Address - Street 2:470
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3505
Practice Address - Country:US
Practice Address - Phone:773-661-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst