Provider Demographics
NPI:1518859107
Name:JANIK, JACOB (PMHNP)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:JANIK
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:MR
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:JANIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:11105 W ELMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11105 W ELMWOOD CT
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9215
Practice Address - Country:US
Practice Address - Phone:815-557-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209032650363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health