Provider Demographics
NPI:1689681090
Name:JEBENS, SHELLY MADISON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:MADISON
Last Name:JEBENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6513 KARINCREST DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9586
Mailing Address - Country:US
Mailing Address - Phone:513-884-2495
Mailing Address - Fax:
Practice Address - Street 1:6513 KARINCREST DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9586
Practice Address - Country:US
Practice Address - Phone:513-884-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6199103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical