Provider Demographics
NPI:1417223645
Name:SHAPPS, KIMBERLY J (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:SHAPPS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N MAY ST APT 2K
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1236
Mailing Address - Country:US
Mailing Address - Phone:312-545-3070
Mailing Address - Fax:312-243-7822
Practice Address - Street 1:2528 N LINCOLN AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2333
Practice Address - Country:US
Practice Address - Phone:312-545-3070
Practice Address - Fax:312-243-7822
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490133011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical