Provider Demographics
NPI:1336318872
Name:HENNING, JANNA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANNA
Middle Name:A
Last Name:HENNING
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 1:4633 N WESTERN AVE
Mailing Address - Street 2:LOFT OFFICES, SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2181
Mailing Address - Country:US
Mailing Address - Phone:773-860-1417
Mailing Address - Fax:
Practice Address - Street 1:4633 N WESTERN AVE
Practice Address - Street 2:LOFT OFFICES, SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2181
Practice Address - Country:US
Practice Address - Phone:773-860-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical