Healthcare Provider Details

I. General information

NPI: 1417912049
Provider Name (Legal Business Name): JANEEN MARIE PLOGGER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3248 VANDEVER
PEKIN IL
61554
US

IV. Provider business mailing address

3248 VANDEVER
PEKIN IL
61554
US

V. Phone/Fax

Practice location:
  • Phone: 309-347-5579
  • Fax: 309-347-7302
Mailing address:
  • Phone: 309-347-5579
  • Fax: 309-347-7302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: