MEDICARE: DR. JANEIL NELLIS RUIZ PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071.008116	IL

General Provider Information

NPI Number	:	1033306451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANEIL NELLIS RUIZ PSY.D.

Provider Business Mailing Address
First Line	:	1333 N ARTESIAN AVE
Second Line	:	#2
City	:	CHICAGO
State	:	IL
Zip	:	60622-2935
Country	:	US
Telephone Number	:	773-627-2112
Fax Number	:

Provider Business Practice Location Address
First Line	:	2950 W CHICAGO AVE
Second Line	:	SUITE 302 C
City	:	CHICAGO
State	:	IL
Zip	:	60622-4375
Country	:	US
Telephone Number	:	773-627-2112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2007
Last Update Date	:	11/14/2011

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