Provider Demographics
NPI:1467623389
Name:JANUSCHKA, SUSAN ROSE (BS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ROSE
Last Name:JANUSCHKA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:333 NORTH SMITH AVE
Mailing Address - Street 2:UNITED HOSPITAL
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-241-8290
Mailing Address - Fax:651-241-7177
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:SISTER KENNEY OT DEPT
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-241-8290
Practice Address - Fax:651-241-7177
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101339225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist