Provider Demographics
NPI:1518531755
Name:JAHNEL, AMY MARGUERITE (MS, ATC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARGUERITE
Last Name:JAHNEL
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARGUERITE
Other - Last Name:HEINRICHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC
Mailing Address - Street 1:2300 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7661
Mailing Address - Country:US
Mailing Address - Phone:217-383-9400
Mailing Address - Fax:
Practice Address - Street 1:2300 S 1ST ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7661
Practice Address - Country:US
Practice Address - Phone:217-383-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0027972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer