Provider Demographics
NPI:1720112337
Name:JANESE R VENDL
Entity Type:Organization
Organization Name:JANESE R VENDL
Other - Org Name:JANESE VENDL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANESE
Authorized Official - Middle Name:R
Authorized Official - Last Name:VENDL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:847-695-7719
Mailing Address - Street 1:541 WATERS EDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177
Mailing Address - Country:US
Mailing Address - Phone:847-695-7719
Mailing Address - Fax:
Practice Address - Street 1:541 WATERS EDGE DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177
Practice Address - Country:US
Practice Address - Phone:847-695-7719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty