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General NPI Number Information
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NPI Number | 1619954401
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Entity Type | Individual
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Provider Name | JANICE B FOOTLIK MA LCPC NCC CCCJS NA
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Gender | Female
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2521 GROSS POINT RD 2ND FLOOR
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City | EVANSTON
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State | IL
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Zip | 60201-4993
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Country | US
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Telephone | 847-866-9625
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Fax | 847-328-6868
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Provider Business Mailing Address
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Address Line | 2526 WELLINGTON CT
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City | EVANSTON
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State | IL
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Zip | 60201-4975
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Country | US
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Telephone | 847-866-9625
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Fax | 847-328-6868
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1020090
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | A17526
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | IL
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