MEDICARE: JUDITH ANN JANKOWSKI LPCC-S, LICDC,ATR-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1225253107	OH

General Provider Information

NPI Number	:	1225493315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH ANN JANKOWSKI LPCC-S, LICDC,ATR-BC

Provider Business Mailing Address
First Line	:	14515 KREMS AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	843 N CLEVELAND MASSILLON RD STE 6
Second Line	:
City	:	FAIRLAWN
State	:	OH
Zip	:	44333-2184
Country	:	US
Telephone Number	:	330-723-7977
Fax Number	:	330-725-5177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	12/19/2015

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