Provider Demographics
NPI:1669795837
Name:SHEALY, JILL ANNE
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:ANNE
Last Name:SHEALY
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 1:7029 N WALL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-5151
Mailing Address - Country:US
Mailing Address - Phone:503-208-4049
Mailing Address - Fax:971-346-4489
Practice Address - Street 1:7029 N WALL AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-5151
Practice Address - Country:US
Practice Address - Phone:503-208-4049
Practice Address - Fax:971-346-4489
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2025-09-08
Deactivation Date:2019-08-02
Deactivation Code:
Reactivation Date:2020-12-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health