Provider Demographics
NPI:1205898897
Name:SULLIVAN, JANET GROESCH (ATC)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:GROESCH
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:LYNN
Other - Last Name:GROESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2211 RILEY CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5384
Mailing Address - Country:US
Mailing Address - Phone:630-922-8345
Mailing Address - Fax:
Practice Address - Street 1:2940 ROLLINGRIDGE RD
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4216
Practice Address - Country:US
Practice Address - Phone:630-527-0485
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960019952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer