MEDICARE: MS. JANNA LEE CHILDS LMT

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	225700000X	Massage Therapist	227001917	IL

General Provider Information

NPI Number	:	1184588527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANNA LEE CHILDS LMT

Provider Business Mailing Address
First Line	:	1721 ASHLAND AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-3545
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4753 N BROADWAY ST STE 401
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4981
Country	:	US
Telephone Number	:	312-278-7288
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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