Healthcare Provider Details

I. General information

NPI: 1184588527
Provider Name (Legal Business Name): JANNA LEE CHILDS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4753 N BROADWAY ST STE 401
CHICAGO IL
60640-4981
US

IV. Provider business mailing address

1721 ASHLAND AVE
EVANSTON IL
60201-3545
US

V. Phone/Fax

Practice location:
  • Phone: 312-278-7288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227001917
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: