Provider Demographics
NPI:1861694465
Name:DOYLE, SHANNON S (PHD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:S
Last Name:DOYLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W COLLEGE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1900
Mailing Address - Country:US
Mailing Address - Phone:847-814-9447
Mailing Address - Fax:
Practice Address - Street 1:11 W COLLEGE DR
Practice Address - Street 2:SUITE B
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1900
Practice Address - Country:US
Practice Address - Phone:847-814-9447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623145OtherBCBS PROVIDER #
IL1623145OtherBCBS PROVIDER #
ILK09078Medicare ID - Type Unspecified