Provider Demographics
NPI:1306179908
Name:KAHN, JILL SHELLEY (MA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SHELLEY
Last Name:KAHN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1558
Mailing Address - Country:US
Mailing Address - Phone:208-263-1796
Mailing Address - Fax:208-263-8086
Practice Address - Street 1:502 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1558
Practice Address - Country:US
Practice Address - Phone:208-263-1796
Practice Address - Fax:208-263-8086
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 1038101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor