Provider Demographics
NPI:1316788961
Name:BURNOM, JANICE ELAINE (MA)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:ELAINE
Last Name:BURNOM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1624
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-7620
Mailing Address - Country:US
Mailing Address - Phone:312-504-2229
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1624
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-7620
Practice Address - Country:US
Practice Address - Phone:312-504-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional