Provider Demographics
NPI:1023783800
Name:PARKER, JANIS (MA)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7415 N PAULINA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1896
Mailing Address - Country:US
Mailing Address - Phone:479-462-9133
Mailing Address - Fax:
Practice Address - Street 1:5756 N RIDGE AVE STE 9
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-5332
Practice Address - Country:US
Practice Address - Phone:773-657-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017051101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor