Healthcare Provider Details

I. General information

NPI: 1558275610
Provider Name (Legal Business Name): MS. MONA JANTZI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E STREET RD
KENNETT SQUARE PA
19348-1702
US

IV. Provider business mailing address

21 TOWER RD
BROOMALL PA
19008-4417
US

V. Phone/Fax

Practice location:
  • Phone: 484-228-1859
  • Fax:
Mailing address:
  • Phone: 610-368-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: