MEDICARE: KATHERINE ANN JANICKI

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	101YM0800X	Mental Health Counselor	PC009851	PA

General Provider Information

NPI Number	:	1336603836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ANN JANICKI

Provider Business Mailing Address
First Line	:	80 EMERSON LN STE 1303
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-3472
Country	:	US
Telephone Number	:	412-221-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 EMERSON LN STE 1303
Second Line	:
City	:	BRIDGEVILLE
State	:	PA
Zip	:	15017-3472
Country	:	US
Telephone Number	:	412-221-7770
Fax Number	:

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

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	01/29/2019

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