Provider Demographics
NPI:1851565766
Name:ALI, SHIREEN
Entity Type:Individual
Prefix:
First Name:SHIREEN
Middle Name:
Last Name:ALI
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 1:6120 GRAND CENTRAL PKWY
Mailing Address - Street 2:C1403
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1263
Mailing Address - Country:US
Mailing Address - Phone:224-558-9515
Mailing Address - Fax:
Practice Address - Street 1:9401 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1080
Practice Address - Country:US
Practice Address - Phone:224-558-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities