Provider Demographics
NPI:1487471439
Name:WOODS, SHELBY RYAN
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:RYAN
Last Name:WOODS
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 1:3755 E MAIN ST STE 190
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2463
Mailing Address - Country:US
Mailing Address - Phone:630-549-6245
Mailing Address - Fax:630-701-9500
Practice Address - Street 1:3755 E MAIN ST STE 190
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2463
Practice Address - Country:US
Practice Address - Phone:630-549-6245
Practice Address - Fax:630-701-9500
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178021318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional