Provider Demographics
NPI:1861631525
Name:WAHLEN, JANA MARIE (AUD)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:MARIE
Last Name:WAHLEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:MARIE
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:375 N WALL ST STE P620
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3487
Mailing Address - Country:US
Mailing Address - Phone:815-928-5098
Mailing Address - Fax:815-936-3850
Practice Address - Street 1:375 N WALL ST STE P620
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3487
Practice Address - Country:US
Practice Address - Phone:815-928-5098
Practice Address - Fax:815-936-3850
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000128231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist