Active NPI
Janice B Footlik, MA LCPC NCC CCCJS NA
- Psychologist
- Evanston, IL
National Provider Identifier
1619954401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1020090
- Practice address
- 2521 Gross Point Rd
2ND Floor
Evanston, IL 60201-4993 - Phone
- (847) 866-9625
- Fax
- (847) 328-6868
- NPI assigned
- Dec 22, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1020090 | IL | Primary |
| Psychologist | 103T00000X | A17526 | ||
| Psychologist | 103T00000X | IL |
Addresses
Primary practice location
2521 Gross Point Rd
2ND Floor
Evanston, IL 60201-4993
Mailing address
2526 Wellington CT
Evanston, IL 60201-4975
Phone (847) 866-9625
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0007607959 | Other | IL | BLUE CROSS BLUE SHIELD |
| 17526 | Other | NAFC PROVIDER | |
| 7481658 | Other | IL | AETNA INS PROVIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1020090 | IL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1619954401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2526 WELLINGTON CT",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602014975",
"telephone_number": "847-866-9625",
"fax_number": "847-328-6868"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2521 GROSS POINT RD",
"address_2": "2ND FLOOR",
"city": "EVANSTON",
"state": "IL",
"postal_code": "602014993",
"telephone_number": "847-866-9625",
"fax_number": "847-328-6868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOOTLIK",
"first_name": "JANICE",
"middle_name": "B",
"name_prefix": "Miss",
"credential": "MA LCPC NCC CCCJS NA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-22",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "1020090",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": "A17526",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "0007607959",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NAFC PROVIDER",
"identifier": "17526",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA INS PROVIDER",
"identifier": "7481658",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evanston, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.