Healthcare Provider Details

I. General information

NPI: 1487127981
Provider Name (Legal Business Name): MIRANDA LYNN JANKOWSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 W ASH ST STE 100
WINDSOR CO
80550-4783
US

IV. Provider business mailing address

1300 N 17TH AVE
GREELEY CO
80631-9584
US

V. Phone/Fax

Practice location:
  • Phone: 970-347-2120
  • Fax:
Mailing address:
  • Phone: 970-347-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0016298
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0016744
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierLPC.0016744
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerDEPARTMENT OF REGULATORY AGENCIES

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: