Healthcare Provider Details

I. General information

NPI: 1477871267
Provider Name (Legal Business Name): JANET HELEN MCCLINTOCK RN, MSN, LPC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 N PORT WASHINGTON RD
GLENDALE WI
53217-4308
US

IV. Provider business mailing address

6110 N PORT WASHINGTON RD
GLENDALE WI
53217-4308
US

V. Phone/Fax

Practice location:
  • Phone: 414-704-4560
  • Fax:
Mailing address:
  • Phone: 414-704-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1916-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number72287-30
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number72287-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: