Provider Demographics
NPI:1205076056
Name:HALL-NANNINI, SHANNON NOELLE (MSW, LSW)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:NOELLE
Last Name:HALL-NANNINI
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 MEACHAM RD
Mailing Address - Street 2:
Mailing Address - City:KINMUNDY
Mailing Address - State:IL
Mailing Address - Zip Code:62854-3415
Mailing Address - Country:US
Mailing Address - Phone:618-245-2367
Mailing Address - Fax:
Practice Address - Street 1:2014 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4848
Practice Address - Country:US
Practice Address - Phone:618-345-9536
Practice Address - Fax:618-345-9587
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.011940104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker