Provider Demographics
NPI:1295264281
Name:SHLAES, JENNIFER (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SHLAES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HUBERMAN-SHLAES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:640 W MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-0466
Mailing Address - Country:US
Mailing Address - Phone:312-286-6165
Mailing Address - Fax:
Practice Address - Street 1:737 N MICHIGAN AVE STE 1200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6656
Practice Address - Country:US
Practice Address - Phone:312-544-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009552103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical