Provider Demographics
NPI:1033133640
Name:SCHANK, JANET ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:ANN
Last Name:SCHANK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CLEVELAND AVE SOUTH
Mailing Address - Street 2:#209
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116
Mailing Address - Country:US
Mailing Address - Phone:612-270-0243
Mailing Address - Fax:651-690-0968
Practice Address - Street 1:790 CLEVELAND AVE SOUTH
Practice Address - Street 2:#209
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116
Practice Address - Country:US
Practice Address - Phone:612-270-0243
Practice Address - Fax:651-690-0968
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0638103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN259570Medicaid
MN968109400Medicaid