SHANNA MARIE KURTH (NPI# 1891800603) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891800603 |
| Entity Type | Individual |
| Full Name | SHANNA MARIE KURTH |
| Credential | PHD |
| Practice Address |
3100 N Dries Ln Ste 303 Peoria IL 61604-1265 |
| Practice Telephone | 3096869005 |
| Practice Fax Number | 3096869020 |
| Mailing Telephone | 3096869005 |
| Mailing Fax Number | 3096869020 |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2013-05-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | 071004929 | IL | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS OF IL | 0007226636 | 01 |
| Street Address |
3100 N DRIES LN STE 303 |
| City | PEORIA |
| State | IL |
| Zip Code | 61604-1265 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851554224 | Mindock Counseling and Consulting | Counselor | 3100 N Dries Ln, Suite 302, Peoria, IL 61604-1259 | 2008-07-07 |
| 1659553444 | Neuropsychology Clinic PC | Clinical Neuropsychologist | 3100 N Dries Ln, Ste 303, Peoria, IL 61604-1265 | 2007-12-04 |
| 1669564290 | Randal Mark Kowalske | Dentist | 3100 N Dries Ln, Suite 301, Peoria, IL 61604-1265 | 2006-09-29 |
| 1558462499 | Keith Edward Kowalske | Optometrist | 3100 N Dries Ln, Suite 101, Peoria, IL 61604-1259 | 2006-09-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205357928 | Nydia I Rodriguez | Nurse's Aide | 3305 N Finnell Ave, Peoria, IL 61604 | 2017-07-03 |
| 1720327976 | Brin Diagnostics Inc. | Clinical Medical Laboratory | 3216 W Kenwood, West Peoria, IL 61604 | 2013-02-07 |
| 1225373715 | Ngocyen Thi Ngo | Pharmacist | 2515 N Knoxville Avenue, Peoria, IL 61604 | 2012-12-10 |
| 1194027003 | Schelly Chiropractic, Inc | Chiropractor | 1208 W Loucks, Peoria, IL 61604 | 2010-11-29 |
| 1770755852 | Dental Sealants & More | Dentist | 2126 N. University St., Peoria, IL 61604 | 2008-03-28 |
| 1821266123 | David L Krick | Dentist | 2022 N University, Peoria, IL 61604 | 2008-02-20 |
| 1568658409 | Advanced Physicians Health Care, S.c. | Chiropractor | 1200 West Loucks Ave, Peoria, IL 61604 | 2007-09-24 |
| 1902006000 | Noel Liu | Dentist | 3127 N. University St., Unit C, Peoria, IL 61604 | 2007-07-18 |
| 1568586386 | Susan B Bordenave-bishop | Dentist | 2116 N. Sheridan, Peoria, IL 61604 | 2007-03-19 |
| 1174689897 | Paul Anthony Amodeo | Dentist | 3100 N Dries Lane, Suite 301, Peoria, IL 61604 | 2006-12-28 |
| Find all providers in zip 61604 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174927172 | Christopher Simpson | Clinical Neuropsychologist | 10184 W Happy Valley Rd, Suite 190, Peoria, AZ 85383-1254 | 2014-10-20 |
| 1003425786 | Brycie Weiden | Clinical Neuropsychologist | 515 Ne Glen Oak Ave Ste 101, Peoria, IL 61603-3167 | 2020-07-28 |
| 1649723990 | Eric Aune | Clinical Neuropsychologist | 530 Ne Glen Oak Ave, Children's Hospital of Illinois, Peoria, IL 61637-0001 | 2016-08-03 |
| 1053658377 | Benjamin Joseph Richter | Clinical Neuropsychologist | 515 Ne Glen Oak Ave, Suite 101, Peoria, IL 61637-3167 | 2013-01-07 |
| 1740459429 | Amy Serin | Clinical Neuropsychologist | 10200 W Happy Valley Rd, Suite A135, Peoria, AZ 85383-2878 | 2008-02-26 |
| 1659553444 | Neuropsychology Clinic PC | Clinical Neuropsychologist | 3100 N Dries Ln, Ste 303, Peoria, IL 61604-1265 | 2007-12-04 |
| 1659396505 | Michele R. Verda | Clinical Neuropsychologist | 420 Ne Glen Oak Ave, 401, Peoria, IL 61603-3105 | 2006-07-13 |
| 1962456764 | Saint Francis Medical Center | Clinical Neuropsychologist | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2006-05-19 |
| 1831181726 | Dietra Duffala Teichmann | Clinical Neuropsychologist | 5401 N Knoxville Ave, Suite 217, Peoria, IL 61614-5098 | 2005-08-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477183556 | Michelle Yvonne Kibby-faglier | Clinical Neuropsychologist | 285 Lake Indian Hills Dr, Carbondale, IL 62902-6184 | 2020-01-17 |
| 1003456708 | David Jackson | Clinical Neuropsychologist | 6 Parkway North Blvd, Deerfield, IL 60015-2522 | 2020-01-10 |
| 1649830159 | Natalie Berger | Clinical Neuropsychologist | 1645 W Jackson Blvd Ste 203, Chicago, IL 60612-3227 | 2019-06-17 |
| 1043877475 | Sarah Mailander Dyer | Clinical Neuropsychologist | 900 Royal Heights Rd Ste 14, Belleville, IL 62226-5457 | 2019-05-21 |
| 1639655632 | Julia Digangi | Clinical Neuropsychologist | 920 N York Rd, Hinsdale, IL 60521-2996 | 2018-07-13 |
| 1891211710 | Kenneth Vicencio | Clinical Neuropsychologist | 4100 Healthway Drive, Aurora, IL 60504 | 2017-08-22 |
| 1538690466 | Kathleen Ares | Clinical Neuropsychologist | 4440 W 95th, Suite 1200h, Oak Lawn, IL 60453 | 2017-03-22 |
| 1225575871 | Israel Gross | Clinical Neuropsychologist | 1934 W. Roscoe St., #4, Chicago, IL 60657 | 2017-01-20 |
| 1013462829 | Ann Westcot Jordan | Clinical Neuropsychologist | 21037 Benjamin Dr, Shorewood, IL 60404-0612 | 2016-08-22 |
| 1740638915 | Elizabeth Regina Tuminello Hartman | Clinical Neuropsychologist | 1875 Dempster St Ste 520, Park Ridge, IL 60068-1130 | 2016-05-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.