| Doctor Name: | THERESA MARIE SHIMMIN |
| NPI Number: | 1619256344 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1913 W Townline Rd Peoria, IL - 616151621 |
| Business Phone Number: | 3096913800 |
| Business Fax Number: | 3096913800 |
| Mailing Address: | 5005 N Ogden Ave, PEORIA HEIGHTS |
| State: | IL |
| Postal Code: | 616165142 |
| Phone Number: | 3096913800 |
| Fax Number: | 3096893613 |
| NPI Enumeration Date: | 08/11/2011 |
| NPI Last Update Date: | 08/11/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |