Provider Demographics
NPI:1821222167
Name:JUMONVILLE, JANEAN ROSE I
Entity Type:Individual
Prefix:MISS
First Name:JANEAN
Middle Name:ROSE
Last Name:JUMONVILLE
Suffix:I
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 1:32 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1367
Mailing Address - Country:US
Mailing Address - Phone:219-671-7460
Mailing Address - Fax:
Practice Address - Street 1:30 E HURON ST APT 1106
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2787
Practice Address - Country:US
Practice Address - Phone:847-997-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst