Provider Demographics
NPI:1861467284
Name:ITZKOWITZ, JAN WENDY (MED, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:WENDY
Last Name:ITZKOWITZ
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 INDIAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3208
Mailing Address - Country:US
Mailing Address - Phone:847-459-1737
Mailing Address - Fax:847-459-1737
Practice Address - Street 1:404 INDIAN HILL DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3208
Practice Address - Country:US
Practice Address - Phone:847-459-1737
Practice Address - Fax:847-459-1737
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL011281622OtherHUMANA
IL04932072OtherBLU CROSS/BLUE SHIELD