Provider Demographics
NPI:1598567638
Name:SIMON, SHIRA (MM, LPMT, MT-BC)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:SIMON
Suffix:
Gender:
Credentials:MM, LPMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 W ELMDALE AVE UNIT 2E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4964
Mailing Address - Country:US
Mailing Address - Phone:847-651-6005
Mailing Address - Fax:
Practice Address - Street 1:1328 W ELMDALE AVE UNIT 2E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-4964
Practice Address - Country:US
Practice Address - Phone:847-651-6005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist