Healthcare Provider Details

I. General information

NPI: 1013118397
Provider Name (Legal Business Name): JANINE TEDESCO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 TEMPERANCE ST.
SASKATOON SASKATCHEWAN
S7N 0N3
CA

IV. Provider business mailing address

903 TEMPERANCE ST.
SASKATOON SASKATCHEWAN
S7N 0N3
CA

V. Phone/Fax

Practice location:
  • Phone: 306-652-5975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000671
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: