Healthcare Provider Details

I. General information

NPI: 1578480513
Provider Name (Legal Business Name): SHIH-HSUAN LIN PHD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E PENNSYLVANIA AVE STE 107
PEORIA IL
61603-3045
US

IV. Provider business mailing address

200 E PENNSYLVANIA AVE STE 107
PEORIA IL
61603-3045
US

V. Phone/Fax

Practice location:
  • Phone: 309-655-7378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number071.022712
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: