Provider Demographics
NPI:1790461499
Name:VANGALIS, JENNA (OTD, OT/R)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:VANGALIS
Suffix:
Gender:F
Credentials:OTD, OT/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W WELLINGTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9713
Mailing Address - Country:US
Mailing Address - Phone:312-315-3639
Mailing Address - Fax:
Practice Address - Street 1:280 SAUNDERS RD
Practice Address - Street 2:
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-3835
Practice Address - Country:US
Practice Address - Phone:847-948-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.015508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist