Provider Demographics
NPI:1619642329
Name:DEWITT-GOODMAN, JANET IRENE (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:IRENE
Last Name:DEWITT-GOODMAN
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 FAIRFAX LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-2942
Mailing Address - Country:US
Mailing Address - Phone:630-730-7823
Mailing Address - Fax:
Practice Address - Street 1:1513 FAIRFAX LN
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-2942
Practice Address - Country:US
Practice Address - Phone:630-730-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041241492163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant