Provider Demographics
NPI:1326480450
Name:OMAHEN, JING
Entity type:Individual
Prefix:MS
First Name:JING
Middle Name:
Last Name:OMAHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JING
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18829 S VANDERBILT DR
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8885
Mailing Address - Country:US
Mailing Address - Phone:574-229-6219
Mailing Address - Fax:
Practice Address - Street 1:18829 S VANDERBILT DR
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8885
Practice Address - Country:US
Practice Address - Phone:574-229-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-21-53413103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst