Provider Demographics
NPI:1982852711
Name:REID, JANE ELLEN (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELLEN
Last Name:REID
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N CHESTNUT ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-4037
Mailing Address - Country:US
Mailing Address - Phone:217-398-0113
Mailing Address - Fax:
Practice Address - Street 1:116 N CHESTNUT ST
Practice Address - Street 2:SUITE 214
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4037
Practice Address - Country:US
Practice Address - Phone:217-398-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490100401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical