Provider Demographics
NPI:1932239514
Name:MOSKOWITZ, JOAN ELLEN (M ED)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ELLEN
Last Name:MOSKOWITZ
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-3079
Mailing Address - Country:US
Mailing Address - Phone:847-459-0277
Mailing Address - Fax:847-459-0970
Practice Address - Street 1:190 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3079
Practice Address - Country:US
Practice Address - Phone:847-459-0277
Practice Address - Fax:847-459-0970
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJM84380698P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist