Provider Demographics
NPI:1528267481
Name:O'NEILL, SHANNON COLLEEN
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:COLLEEN
Last Name:O'NEILL
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 1:1200 W. MONROE ST
Mailing Address - Street 2:#512
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607
Mailing Address - Country:US
Mailing Address - Phone:708-704-6775
Mailing Address - Fax:
Practice Address - Street 1:1200 W MONROE ST
Practice Address - Street 2:#512
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2565
Practice Address - Country:US
Practice Address - Phone:708-704-6775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.000572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist