Provider Demographics
NPI:1568930725
Name:PLATO, JUANETTE M
Entity Type:Individual
Prefix:
First Name:JUANETTE
Middle Name:M
Last Name:PLATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314
Mailing Address - Country:US
Mailing Address - Phone:515-601-6547
Mailing Address - Fax:
Practice Address - Street 1:1745 E CLAY ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3032
Practice Address - Country:US
Practice Address - Phone:305-902-6347
Practice Address - Fax:515-266-6808
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT18059101YA0400X
IL180014671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)