Provider Demographics
NPI:1164253340
Name:SHEA, EMILY VALENTINA
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:VALENTINA
Last Name:SHEA
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:EM
Other - Middle Name:
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2652 N SOUTHPORT AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-0802
Mailing Address - Country:US
Mailing Address - Phone:630-532-1045
Mailing Address - Fax:
Practice Address - Street 1:415 WASHINGTON ST STE 200
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-5564
Practice Address - Country:US
Practice Address - Phone:630-532-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor