Provider Demographics
NPI:1235371550
Name:SHIN, ESTHER DONGHE
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:DONGHE
Last Name:SHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 N PAULINA ST
Mailing Address - Street 2:UNIT 516
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1133
Mailing Address - Country:US
Mailing Address - Phone:312-209-0275
Mailing Address - Fax:
Practice Address - Street 1:1735 N PAULINA ST
Practice Address - Street 2:UNIT 516
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1133
Practice Address - Country:US
Practice Address - Phone:312-209-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007052101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional