Provider Demographics
NPI:1497028336
Name:ROBERTS, JANELLE DIANE (BA, ED)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:DIANE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BA, ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 POTOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-3423
Mailing Address - Country:US
Mailing Address - Phone:253-318-6835
Mailing Address - Fax:
Practice Address - Street 1:712 POTOMAC AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-3423
Practice Address - Country:US
Practice Address - Phone:331-472-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor