MEDICARE: JILL L. JANECKE M.S., LPC-MH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2181	SD

General Provider Information

NPI Number	:	1659515310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL L. JANECKE M.S., LPC-MH

Provider Business Mailing Address
First Line	:	412 W MISSOURI AVE
Second Line	:
City	:	PIERRE
State	:	SD
Zip	:	57501-4520
Country	:	US
Telephone Number	:	605-494-1500
Fax Number	:	605-494-1501

Provider Business Practice Location Address
First Line	:	2214 LEVEE ST
Second Line	:
City	:	FORT PIERRE
State	:	SD
Zip	:	57532-2282
Country	:	US
Telephone Number	:	605-691-5825
Fax Number	:	605-494-1501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2009
Last Update Date	:	12/25/2017

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