Provider Demographics
NPI:1639647704
Name:SHAH, JIGNA B (LPC)
Entity Type:Individual
Prefix:
First Name:JIGNA
Middle Name:B
Last Name:SHAH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10164 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1557
Mailing Address - Country:US
Mailing Address - Phone:847-297-4929
Mailing Address - Fax:
Practice Address - Street 1:999 CIVIC CENTER DR FL 3
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3224
Practice Address - Country:US
Practice Address - Phone:847-588-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty