Provider Demographics
NPI:1215211040
Name:SMALLWOOD, JAN C (LPC)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:C
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W JOHN ST
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-9249
Mailing Address - Country:US
Mailing Address - Phone:630-553-9100
Mailing Address - Fax:630-553-0167
Practice Address - Street 1:811 W JOHN ST
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-9249
Practice Address - Country:US
Practice Address - Phone:630-553-9100
Practice Address - Fax:630-553-0167
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health