Provider Demographics
NPI:1336546308
Name:JANKOWSKI, LEAH (MED, ATC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:JANKOWSKI
Suffix:
Gender:F
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 HAMPTON RIDGE DR
Mailing Address - Street 2:APT 12
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-6071
Mailing Address - Country:US
Mailing Address - Phone:414-238-3326
Mailing Address - Fax:
Practice Address - Street 1:4401 PEAK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-8001
Practice Address - Country:US
Practice Address - Phone:815-668-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960036842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer