Provider Demographics
NPI:1700868924
Name:REISCH, JANICE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:M
Last Name:REISCH
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:1660 N LASALLE ST
Mailing Address - Street 2:#402
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-6000
Mailing Address - Country:US
Mailing Address - Phone:312-787-7441
Mailing Address - Fax:312-642-2686
Practice Address - Street 1:450 SAINT JOHN RD
Practice Address - Street 2:SUITE 301-18
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7354
Practice Address - Country:US
Practice Address - Phone:312-787-7441
Practice Address - Fax:312-642-2686
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical