Healthcare Provider Details

I. General information

NPI: 1184999831
Provider Name (Legal Business Name): EMILY LYN JANKOWSKI M.S., LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 CRAWFORD RD
DERBY VT
05829-6405
US

IV. Provider business mailing address

907 ELM ST
DERBY LINE VT
05830-8881
US

V. Phone/Fax

Practice location:
  • Phone: 802-334-6744
  • Fax: 802-334-7340
Mailing address:
  • Phone: 802-881-2639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0057644
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: