MEDICARE: ESTHER DONGHE SHIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	180.007052	IL
2	101YP2500X	Professional Counselor	180.007052	IL

General Provider Information

NPI Number	:	1235371550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ESTHER DONGHE SHIN

Provider Business Mailing Address
First Line	:	1735 N PAULINA ST
Second Line	:	UNIT 516
City	:	CHICAGO
State	:	IL
Zip	:	60622-1133
Country	:	US
Telephone Number	:	312-209-0275
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 N PAULINA ST
Second Line	:	UNIT 516
City	:	CHICAGO
State	:	IL
Zip	:	60622-1133
Country	:	US
Telephone Number	:	312-209-0275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/14/2014

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Directions to “ ESTHER DONGHE SHIN ” Practice Location

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