Provider Demographics
NPI:1144501511
Name:SHEDRICK, PATRICIA JEAN
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JEAN
Last Name:SHEDRICK
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 1:7337 S CALUMET AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-1723
Mailing Address - Country:US
Mailing Address - Phone:773-873-6618
Mailing Address - Fax:
Practice Address - Street 1:7337 S CALUMET AVE
Practice Address - Street 2:APT 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-1723
Practice Address - Country:US
Practice Address - Phone:773-873-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPS30340499P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist