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General NPI Number Information
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NPI Number | 1730704503
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Entity Type | Individual
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Provider Name | KATIE LYNN JANIK MSW, APSW
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Gender | Female
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 5555 ODANA RD STE 202
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City | MADISON
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State | WI
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Zip | 53719-1280
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Country | US
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Telephone | 608-209-3866
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Fax |
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Provider Business Mailing Address
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Address Line | 214 KLEINE ST
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City | DEERFIELD
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State | WI
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Zip | 53531-9596
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Country | US
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Telephone | 414-430-0655
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 131483-121
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License Number State | WI
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