Provider Demographics
NPI:1033390208
Name:SHIBLEY, JENNIFER REBECCA (PSYD, MS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:REBECCA
Last Name:SHIBLEY
Suffix:
Gender:F
Credentials:PSYD, MS
Other - Prefix:
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Mailing Address - Street 1:900 MAIN ST STE 780
Mailing Address - Street 2:SUITE 780
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1067
Mailing Address - Country:US
Mailing Address - Phone:309-706-3190
Mailing Address - Fax:309-588-4115
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:SUITE 780
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1005
Practice Address - Country:US
Practice Address - Phone:309-672-5946
Practice Address - Fax:309-672-3155
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810003876103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210732OtherMEDICARE
IL05732025OtherBLUE CROSS BLUE SHIELD