Provider Demographics
NPI:1528310737
Name:CLEMENTS, JANET H (CSB)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:H
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:CSB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4615
Mailing Address - Country:US
Mailing Address - Phone:847-220-2089
Mailing Address - Fax:
Practice Address - Street 1:1619 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3710
Practice Address - Country:US
Practice Address - Phone:847-220-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA374K0000X374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner