Provider Demographics
NPI:1942496328
Name:SHINER, JILL EDEN
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:EDEN
Last Name:SHINER
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 1:235 S MARION ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3176
Mailing Address - Country:US
Mailing Address - Phone:708-445-0506
Mailing Address - Fax:
Practice Address - Street 1:235 S MARION ST
Practice Address - Street 2:UNIT A
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3176
Practice Address - Country:US
Practice Address - Phone:708-445-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health