Provider Demographics
NPI:1497541379
Name:AUGUSTUS, JOANNA GAIL
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:GAIL
Last Name:AUGUSTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:GAIL
Other - Last Name:MOREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1667 365N AVE
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:IL
Mailing Address - Zip Code:62378-2107
Mailing Address - Country:US
Mailing Address - Phone:207-651-7882
Mailing Address - Fax:
Practice Address - Street 1:1667 365N AVE
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:IL
Practice Address - Zip Code:62378-2107
Practice Address - Country:US
Practice Address - Phone:207-651-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist