Provider Demographics
NPI:1760561641
Name:MEDAK, JOANNE M (MA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:MEDAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1646
Mailing Address - Country:US
Mailing Address - Phone:847-256-1645
Mailing Address - Fax:847-256-1646
Practice Address - Street 1:1211 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1646
Practice Address - Country:US
Practice Address - Phone:847-256-1645
Practice Address - Fax:847-256-1646
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical