Healthcare Provider Details

I. General information

NPI: 1730879842
Provider Name (Legal Business Name): JANINE VERONICA CWIKLINSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 YALE STREET BILDG 2 STE.150
FLAGSTAFF AZ
86001
US

IV. Provider business mailing address

6125 E INDIAN SCHOOL RD STE 1005
SCOTTSDALE AZ
85251-5469
US

V. Phone/Fax

Practice location:
  • Phone: 928-527-4325
  • Fax:
Mailing address:
  • Phone: 480-877-9284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number16576
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: