Provider Demographics
NPI:1902405020
Name:DAU, JOANNA S
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:S
Last Name:DAU
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:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60039-0377
Mailing Address - Country:US
Mailing Address - Phone:815-276-7786
Mailing Address - Fax:815-788-1321
Practice Address - Street 1:1740 RABBIT VALLEY RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-6921
Practice Address - Country:US
Practice Address - Phone:815-276-7786
Practice Address - Fax:815-788-1321
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist