Healthcare Provider Details

I. General information

NPI: 1699549667
Provider Name (Legal Business Name): DR JANET CHANDLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2036 W FARRAGUT AVE
CHICAGO IL
60625-1202
US

IV. Provider business mailing address

2036 W FARRAGUT AVE
CHICAGO IL
60625-1202
US

V. Phone/Fax

Practice location:
  • Phone: 773-263-7804
  • Fax:
Mailing address:
  • Phone: 773-263-7804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JANET CHANDLER
Title or Position: OWNER
Credential: PHD
Phone: 773-263-7804