Provider Demographics
NPI:1932638012
Name:DR. JENNIFER HUBERMAN-SHLAES, LLC
Entity Type:Organization
Organization Name:DR. JENNIFER HUBERMAN-SHLAES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBERMAN-SHLAES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-286-6165
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071009552261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)