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General NPI Number Information
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NPI Number | 1295264281
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Entity Type | Individual
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Provider Name | JENNIFER SHLAES PHD
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Gender | Female
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Dates
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Enumeration Date | 06/05/2017
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Last Update Date | 06/05/2017
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Provider Practice Location Address
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Address Line | 737 N MICHIGAN AVE STE 1200
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City | CHICAGO
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State | IL
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Zip | 60611-6656
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Country | US
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Telephone | 312-544-0187
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Fax |
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Provider Business Mailing Address
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Address Line | 640 W MELROSE ST
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City | CHICAGO
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State | IL
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Zip | 60657-0466
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Country | US
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Telephone | 312-286-6165
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071009552
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License Number State | IL
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