Provider Demographics
NPI:1437433299
Name:PANOS, BETTY ANNE (MA MULTICAT SPED)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:ANNE
Last Name:PANOS
Suffix:
Gender:F
Credentials:MA MULTICAT SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10507 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-9375
Mailing Address - Country:US
Mailing Address - Phone:708-921-0674
Mailing Address - Fax:
Practice Address - Street 1:10507 CAMDEN CT
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-9375
Practice Address - Country:US
Practice Address - Phone:708-921-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist