Provider Demographics
NPI:1699076158
Name:SHEADE, ALLISON KUPFERBERG (MA, LCPC)
Entity type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:KUPFERBERG
Last Name:SHEADE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 N RAVENSWOOD AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5802
Mailing Address - Country:US
Mailing Address - Phone:773-999-9987
Mailing Address - Fax:847-780-3360
Practice Address - Street 1:4411 N RAVENSWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5802
Practice Address - Country:US
Practice Address - Phone:773-999-9987
Practice Address - Fax:847-780-3360
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009684101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health