Provider Demographics
NPI:1134005895
Name:PETROWSKE, SHEA
Entity type:Individual
Prefix:
First Name:SHEA
Middle Name:
Last Name:PETROWSKE
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 1:1819 SWANWICK ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1125
Mailing Address - Country:US
Mailing Address - Phone:618-615-8620
Mailing Address - Fax:
Practice Address - Street 1:203 DEAN AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-2301
Practice Address - Country:US
Practice Address - Phone:618-443-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.018399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist