Individual
DR. JENNIFER REBECCA SHIBLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D., M.S.
Contact information
Practice address
900 MAIN ST, SUITE 780, PEORIA, IL 61602-1005
(309) 672-5946
(309) 672-3155
Mailing address
900 MAIN ST STE 780, SUITE 780, PEORIA, IL 61602-1067
(309) 706-3190
(309) 588-4115
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810003876
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05732025
BLUE CROSS BLUE SHIELD
IL
01
—
210732
MEDICARE
IL
Enumeration date
11/16/2007
Last updated
04/30/2010
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