Provider Demographics
NPI:1245520246
Name:STILES-SHIELDS, ELIZABETH COLLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:COLLEEN
Last Name:STILES-SHIELDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:STILES-SHIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1700 W VAN BUREN ST STE 5827B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-5500
Mailing Address - Country:US
Mailing Address - Phone:312-563-9012
Mailing Address - Fax:
Practice Address - Street 1:1747 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1264
Practice Address - Country:US
Practice Address - Phone:312-413-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.014597104100000X
IL071.009980103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker