Provider Demographics
NPI:1427128214
Name:PELLER, JANE E
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:E
Last Name:PELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 THAYER ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1412
Mailing Address - Country:US
Mailing Address - Phone:847-424-9344
Mailing Address - Fax:847-475-2691
Practice Address - Street 1:1620 W THOME AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1212
Practice Address - Country:US
Practice Address - Phone:847-424-2934
Practice Address - Fax:847-475-2691
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical