Provider Demographics
NPI:1912085580
Name:MANN, JANE YC (PSYD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:YC
Last Name:MANN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S MICHIGAN AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2696
Mailing Address - Country:US
Mailing Address - Phone:312-808-0900
Mailing Address - Fax:630-653-1025
Practice Address - Street 1:2600 S MICHIGAN AVE STE 408
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2696
Practice Address - Country:US
Practice Address - Phone:312-808-0900
Practice Address - Fax:630-653-1025
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0064961041C0700X
IL071007172103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical