Provider Demographics
NPI:1760220339
Name:CANNON-JANETTAS, KAREN ANNE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ANNE
Last Name:CANNON-JANETTAS
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 1:431 N EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526-5507
Mailing Address - Country:US
Mailing Address - Phone:708-557-6762
Mailing Address - Fax:
Practice Address - Street 1:431 N EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE PARK
Practice Address - State:IL
Practice Address - Zip Code:60526-5507
Practice Address - Country:US
Practice Address - Phone:708-557-6762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist