Individual
MARY E JANUSZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7022 OSAGE DR, MORO, IL 62067-1630
(618) 407-2084
(618) 692-9166
Mailing address
7022 OSAGE DR, MORO, IL 62067-1630
(618) 407-2084
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
MJ92400699P
IL
Other
Enumeration date
04/03/2007
Last updated
07/08/2007
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