Provider Demographics
NPI:1306477989
Name:MILLER, SHEKENA ANN
Entity type:Individual
Prefix:
First Name:SHEKENA
Middle Name:ANN
Last Name:MILLER
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 1:226 W ONTARIO ST STE 400C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3619
Mailing Address - Country:US
Mailing Address - Phone:312-912-7008
Mailing Address - Fax:312-533-2842
Practice Address - Street 1:226 W ONTARIO ST STE 400C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60654-3619
Practice Address - Country:US
Practice Address - Phone:312-912-7008
Practice Address - Fax:312-533-2842
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-7512-0001-A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder