Provider Demographics
NPI:1467955625
Name:HOEKSTRA, SHANNA MARIE (MA, LCSW)
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:MARIE
Last Name:HOEKSTRA
Suffix:
Gender:F
Credentials:MA, LCSW
Other - Prefix:MS
Other - First Name:SHANNA
Other - Middle Name:
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCSW
Mailing Address - Street 1:3590 HOBSON RD STE 401
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1492
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3590 HOBSON RD STE 401
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-1492
Practice Address - Country:US
Practice Address - Phone:630-968-0792
Practice Address - Fax:630-477-0201
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0145981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty