Healthcare Provider Details

I. General information

NPI: 1104645449
Provider Name (Legal Business Name): JANI HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 CHARTRES ST
LA SALLE IL
61301-1107
US

IV. Provider business mailing address

2430 8TH ST
PERU IL
61354-2121
US

V. Phone/Fax

Practice location:
  • Phone: 815-780-8765
  • Fax:
Mailing address:
  • Phone: 815-830-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149023354
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: