Provider Demographics
NPI:1053882704
Name:SHIPPERT, SCOTT THOMAS (LCPC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:SHIPPERT
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S LINCOLNWAY STE F
Mailing Address - Street 2:
Mailing Address - City:NORTH AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60542-1597
Mailing Address - Country:US
Mailing Address - Phone:815-440-8492
Mailing Address - Fax:
Practice Address - Street 1:15025 S DES PLAINES ST STE 101
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-1868
Practice Address - Country:US
Practice Address - Phone:630-428-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013200101YP2500X
IL180012224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional