Healthcare Provider Details

I. General information

NPI: 1528585155
Provider Name (Legal Business Name): MEGAN WOJOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27650 FERRY RD
WARRENVILLE IL
60555-3845
US

IV. Provider business mailing address

17305 S GOUGAR RD
LOCKPORT IL
60441-8276
US

V. Phone/Fax

Practice location:
  • Phone: 630-225-2663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096003076
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: