Provider Demographics
NPI:1528323987
Name:LESSMAN, SHAY EVAN
Entity type:Individual
Prefix:
First Name:SHAY
Middle Name:EVAN
Last Name:LESSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:IL
Mailing Address - Zip Code:61078-9366
Mailing Address - Country:US
Mailing Address - Phone:863-529-3821
Mailing Address - Fax:
Practice Address - Street 1:325 ILLINOIS RT 2
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-9118
Practice Address - Country:US
Practice Address - Phone:815-284-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health