Provider Demographics
NPI:1659631158
Name:SHIMMIN, JEANIE R (PPC)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:R
Last Name:SHIMMIN
Suffix:
Gender:F
Credentials:PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 E C ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-2041
Mailing Address - Country:US
Mailing Address - Phone:307-532-4167
Mailing Address - Fax:
Practice Address - Street 1:1419 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-3340
Practice Address - Country:US
Practice Address - Phone:307-532-4197
Practice Address - Fax:307-532-8405
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-574101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor