Provider Demographics
NPI:1407979818
Name:ALA, JAN
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:ALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62694-8036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 W MORTON
Practice Address - Street 2:SPEECHWORKS
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650
Practice Address - Country:US
Practice Address - Phone:217-473-5274
Practice Address - Fax:217-742-9634
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-002502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist