| Doctor Name: | MRS. KIMBERLY SHANNON DURIS |
| NPI Number: | 1477888576 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC, CADC |
| License Number: | 180-005818 |
| Business Practice Address: | 1701 Bloomingdale Rd Glendale Heights, IL - 601392130 |
| Business Phone Number: | 6302211617 |
| Business Fax Number: | |
| Mailing Address: | Po Box 5432, GLENDALE HEIGHTS |
| State: | IL |
| Postal Code: | 601395432 |
| Phone Number: | 6308620760 |
| Fax Number: | |
| NPI Enumeration Date: | 10/07/2009 |
| NPI Last Update Date: | 10/07/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 180-005818 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |