Provider Demographics
NPI:1295020543
Name:ANNARELLA, JAN PATRICK (M ED)
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:PATRICK
Last Name:ANNARELLA
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4956 N OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1926
Mailing Address - Country:US
Mailing Address - Phone:773-561-5436
Mailing Address - Fax:
Practice Address - Street 1:4956 N OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1926
Practice Address - Country:US
Practice Address - Phone:773-561-5436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst