Provider Demographics
NPI:1477284990
Name:ILIFF, SHANA LEANN
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:LEANN
Last Name:ILIFF
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 1:108 S MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:47394-1809
Mailing Address - Country:US
Mailing Address - Phone:260-239-1457
Mailing Address - Fax:
Practice Address - Street 1:108 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-1809
Practice Address - Country:US
Practice Address - Phone:260-239-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician