Provider Demographics
NPI:1235646316
Name:JILL SHALAN, PHD, PLLC
Entity type:Organization
Organization Name:JILL SHALAN, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-335-3345
Mailing Address - Street 1:68 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2445
Mailing Address - Country:US
Mailing Address - Phone:860-335-3345
Mailing Address - Fax:860-561-6184
Practice Address - Street 1:68 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2445
Practice Address - Country:US
Practice Address - Phone:860-335-3345
Practice Address - Fax:860-561-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2308103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty