1114240108 NPI number — MRS. DAWN L THIELEMANN-SHIELDS MA, LCPC

Table of content: MRS. DAWN L THIELEMANN-SHIELDS MA, LCPC (NPI 1114240108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114240108 NPI number — MRS. DAWN L THIELEMANN-SHIELDS MA, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIELEMANN-SHIELDS
Provider First Name:
DAWN
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114240108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 FAIRLANE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60435-6483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-730-8900
Provider Business Mailing Address Fax Number:
815-730-0988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 FAIRLANE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60435-6483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-730-8900
Provider Business Practice Location Address Fax Number:
815-730-0988
Provider Enumeration Date:
03/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180012571 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: 178.006325 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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