Provider Demographics
NPI:1629371752
Name:DAVIS, JANEA MICHELLE (MS)
Entity type:Individual
Prefix:MISS
First Name:JANEA
Middle Name:MICHELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 FIELDCREST DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3414
Mailing Address - Country:US
Mailing Address - Phone:918-822-1317
Mailing Address - Fax:
Practice Address - Street 1:348 55TH ST
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-3015
Practice Address - Country:US
Practice Address - Phone:630-670-0901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-12
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.001668235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist