Provider Demographics
NPI:1386365799
Name:SHEN, DEBBY
Entity type:Individual
Prefix:
First Name:DEBBY
Middle Name:
Last Name:SHEN
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 1:837 W WRIGHTWOOD AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-0722
Mailing Address - Country:US
Mailing Address - Phone:847-909-6412
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE STE 531
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7426
Practice Address - Country:US
Practice Address - Phone:312-620-1420
Practice Address - Fax:312-345-8444
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.108686104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker