Provider Demographics
NPI:1417353731
Name:JANUSZEWSKI, MEAGN (ATC)
Entity Type:Individual
Prefix:
First Name:MEAGN
Middle Name:
Last Name:JANUSZEWSKI
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6202 STAFFORD ST
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-1704
Mailing Address - Country:US
Mailing Address - Phone:779-205-9775
Mailing Address - Fax:
Practice Address - Street 1:7401 CLARENDON HILLS RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-4288
Practice Address - Country:US
Practice Address - Phone:779-205-9775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960034882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer