Healthcare Provider Details

I. General information

NPI: 1912241555
Provider Name (Legal Business Name): JANIS MICHELE JEPSEN SPECIAL EDUCATION TE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 LIBERTY STREET SUITE 2120
PENN YAN NY
14527
US

IV. Provider business mailing address

3783 COUNTY HOUSE ROAD
PENN YAN NY
14527-8963
US

V. Phone/Fax

Practice location:
  • Phone: 315-536-5160
  • Fax: 315-536-5146
Mailing address:
  • Phone: 315-719-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: