Healthcare Provider Details

I. General information

NPI: 1679616494
Provider Name (Legal Business Name): LYNN JANOVSKY M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 13TH ST
HUNTINGTON WV
25701-1653
US

IV. Provider business mailing address

5919 MAHOOD DR # 4
HUNTINGTON WV
25705-2253
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-7622
  • Fax:
Mailing address:
  • Phone: 412-370-9008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL008583
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-1479
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: