Healthcare Provider Details

I. General information

NPI: 1427541432
Provider Name (Legal Business Name): VICTORIA JILL DAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA JILL SHIRKEY LCPC

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E COLLEGE AVE
NORMAL IL
61761-3078
US

IV. Provider business mailing address

PO BOX 16
MOUNT HERMON CA
95041-0016
US

V. Phone/Fax

Practice location:
  • Phone: 309-431-2139
  • Fax:
Mailing address:
  • Phone: 309-431-2139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180013846
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: