Provider Demographics
NPI:1982718151
Name:HART, JANELL R (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANELL
Middle Name:R
Last Name:HART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1357
Mailing Address - Country:US
Mailing Address - Phone:630-241-2244
Mailing Address - Fax:630-241-2244
Practice Address - Street 1:5500 CARPENTER ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1357
Practice Address - Country:US
Practice Address - Phone:630-241-2244
Practice Address - Fax:630-241-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0044540417; 00322415OtherBC/BS PROVIDER NUMBER