Provider Demographics
NPI:1003185869
Name:ROSENBERG, JANINE ROSE (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:JANINE
Middle Name:ROSE
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:MS
Other - First Name:JANINE
Other - Middle Name:ROSE
Other - Last Name:FRICANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:4400 W 95TH ST
Mailing Address - Street 2:PHYSICIANS' PAVILLION SUITE 207
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2654
Mailing Address - Country:US
Mailing Address - Phone:708-684-1564
Mailing Address - Fax:708-684-4758
Practice Address - Street 1:4400 W 95TH ST
Practice Address - Street 2:PHYSICIANS' PAVILLION SUITE 207
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2654
Practice Address - Country:US
Practice Address - Phone:708-684-1564
Practice Address - Fax:708-684-4758
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246-000117170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS