Individual
MISS JANICE B FOOTLIK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MA LCPC NCC CCCJS NA
Contact information
Practice address
2521 GROSS POINT RD, 2ND FLOOR, EVANSTON, IL 60201-4993
(847) 866-9625
(847) 328-6868
Mailing address
2526 WELLINGTON CT, EVANSTON, IL 60201-4975
(847) 866-9625
(847) 328-6868
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1020090
IL
103T00000X
Psychologist
A17526
—
103T00000X
Psychologist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007607959
BLUE CROSS BLUE SHIELD
IL
01
—
17526
NAFC PROVIDER
—
01
—
7481658
AETNA INS PROVIDER
IL
Enumeration date
12/22/2005
Last updated
07/08/2007
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