Provider Demographics
NPI:1902937287
Name:SHIRLEY, CHRISTINA D
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:D
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 996
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-0996
Mailing Address - Country:US
Mailing Address - Phone:815-469-3886
Mailing Address - Fax:815-469-3886
Practice Address - Street 1:8190 PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-8890
Practice Address - Country:US
Practice Address - Phone:815-469-3886
Practice Address - Fax:815-469-3886
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILN/A222Q00000X
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist