Provider Demographics
NPI:1679120414
Name:SHIELDS, MICHELLE (LPC, CADC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:LPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14049 S HEMINGWAY CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-6035
Mailing Address - Country:US
Mailing Address - Phone:815-295-7333
Mailing Address - Fax:
Practice Address - Street 1:280 SHUMAN BLVD STE 190
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2523
Practice Address - Country:US
Practice Address - Phone:224-538-4378
Practice Address - Fax:630-470-9748
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35665101YA0400X
IL178013971101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)