Provider Demographics
NPI:1538617535
Name:BLINDERMAN, SHANNA LEIGH (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:LEIGH
Last Name:BLINDERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2746 1/2 N HAMPDEN CT
Mailing Address - Street 2:APT. 4CC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1697
Mailing Address - Country:US
Mailing Address - Phone:630-800-7356
Mailing Address - Fax:
Practice Address - Street 1:2746 1/2 N HAMPDEN CT
Practice Address - Street 2:APT. 4CC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1697
Practice Address - Country:US
Practice Address - Phone:630-800-7356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0169461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical