Provider Demographics
NPI:1528280625
Name:NAVICKAS, JEANETTE
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:NAVICKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-7305
Mailing Address - Country:US
Mailing Address - Phone:708-614-9347
Mailing Address - Fax:
Practice Address - Street 1:16744 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2894
Practice Address - Country:US
Practice Address - Phone:708-532-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist