Healthcare Provider Details

I. General information

NPI: 1932239514
Provider Name (Legal Business Name): JOAN ELLEN MOSKOWITZ M. ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 12/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 N MILWAUKEE AVE
WHEELING IL
60090-3079
US

IV. Provider business mailing address

190 N MILWAUKEE AVE
WHEELING IL
60090-3079
US

V. Phone/Fax

Practice location:
  • Phone: 847-459-0277
  • Fax: 847-459-0970
Mailing address:
  • Phone: 847-459-0277
  • Fax: 847-459-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberJM84380698P
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: