Provider Demographics
NPI:1336396670
Name:DOLBEARE-SHAKIN, JODI LYNN (MS, LCPC)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:LYNN
Last Name:DOLBEARE-SHAKIN
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 311
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-280-6238
Mailing Address - Fax:847-681-0608
Practice Address - Street 1:1535 LAKE COOK RD
Practice Address - Street 2:SUITE #112
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1447
Practice Address - Country:US
Practice Address - Phone:847-280-6238
Practice Address - Fax:847-681-0608
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003639101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional