Healthcare Provider Details

I. General information

NPI: 1306376850
Provider Name (Legal Business Name): JANIS A GREENE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W 4TH ST
DULUTH MN
55806-2719
US

IV. Provider business mailing address

221 W 4TH ST
DULUTH MN
55806-2719
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-1227
  • Fax:
Mailing address:
  • Phone: 218-879-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26317
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: