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General NPI Number Information
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NPI Number | 1720763287
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Entity Type | Individual
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Provider Name | BOBBIE JO JANISZ LLMSW
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Gender | Female
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 1401 E VAN DEINSE ST
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City | GREENVILLE
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State | MI
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Zip | 48838-9186
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Country | US
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Telephone | 616-225-4724
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Fax |
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Provider Business Mailing Address
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Address Line | 218 N WILLIAMS ST
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City | MORLEY
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State | MI
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Zip | 49336-9030
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Country | US
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Telephone | 231-307-3098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6851116213
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License Number State | MI
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