Healthcare Provider Details

I. General information

NPI: 1417353731
Provider Name (Legal Business Name): MEAGN JANUSZEWSKI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 CLARENDON HILLS RD
DARIEN IL
60561-4288
US

IV. Provider business mailing address

6202 STAFFORD ST
PLAINFIELD IL
60586-1704
US

V. Phone/Fax

Practice location:
  • Phone: 779-205-9775
  • Fax:
Mailing address:
  • Phone: 779-205-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096003488
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: