Provider Demographics
NPI:1063641983
Name:CANON, JANICE MARILYN (MSW, LCSW, CSW-G)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:MARILYN
Last Name:CANON
Suffix:
Gender:F
Credentials:MSW, LCSW, CSW-G
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4980 S WACO ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2012
Mailing Address - Country:US
Mailing Address - Phone:303-639-6270
Mailing Address - Fax:
Practice Address - Street 1:4980 S WACO ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-2012
Practice Address - Country:US
Practice Address - Phone:303-639-6270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9915491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical