Provider Demographics
NPI:1033306451
Name:RUIZ, JANEIL NELLIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANEIL
Middle Name:NELLIS
Last Name:RUIZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 N ARTESIAN AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2935
Mailing Address - Country:US
Mailing Address - Phone:773-627-2112
Mailing Address - Fax:
Practice Address - Street 1:2950 W CHICAGO AVE
Practice Address - Street 2:SUITE 302 C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4375
Practice Address - Country:US
Practice Address - Phone:773-627-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.008116103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical