Provider Demographics
NPI:1245220920
Name:SHEBAN, LYNNE H (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:H
Last Name:SHEBAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LYNNE
Other - Middle Name:H
Other - Last Name:ROSENZWEIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2861 SHANNON CT
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4379
Mailing Address - Country:US
Mailing Address - Phone:847-673-1743
Mailing Address - Fax:847-714-9869
Practice Address - Street 1:2861 SHANNON CT
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4379
Practice Address - Country:US
Practice Address - Phone:847-673-1743
Practice Address - Fax:847-714-9869
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003373103TC0700X
IL103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
209314Medicare UPIN