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NPI Code Detail

MEDICARE: JIGNA B SHAH LCPC

MEDICARE: JIGNA B SHAH LCPC
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
1101YM0800XMental Health Counselor178.014248IL

General Provider Information

NPI Number : 1639647704
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIGNA B SHAH LCPC
Provider Business Mailing Address
First Line : 10164 MEADOW LN
Second Line :
City : DES PLAINES
State : IL
Zip : 60016-1557
Country : US
Telephone Number : 847-297-4929
Fax Number :
Provider Business Practice Location Address
First Line : 854 TECHNOLOGY WAY
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-5350
Country : US
Telephone Number : 847-816-7203
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2018
Last Update Date : 01/10/2025

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