Provider Demographics
NPI:1164868568
Name:DEVALLAURIS, JANET L (LAC)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:L
Last Name:DEVALLAURIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 RICHARD CT
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-9635
Mailing Address - Country:US
Mailing Address - Phone:847-526-2918
Mailing Address - Fax:
Practice Address - Street 1:1099 BROWN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-3105
Practice Address - Country:US
Practice Address - Phone:847-772-0852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000376171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist