Provider Demographics
NPI:1720135320
Name:JANAS, GINA M (SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:JANAS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 S CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-9308
Mailing Address - Country:US
Mailing Address - Phone:708-645-0715
Mailing Address - Fax:708-645-0649
Practice Address - Street 1:14050 S CEDAR RD
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-9308
Practice Address - Country:US
Practice Address - Phone:708-645-0715
Practice Address - Fax:708-645-0649
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932448OtherBLUE CROSS BLUE SHIELD