Provider Demographics
NPI:1215213004
Name:MARTIN, JANEEN ERIN (CSW)
Entity Type:Individual
Prefix:MISS
First Name:JANEEN
Middle Name:ERIN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1509
Mailing Address - Country:US
Mailing Address - Phone:801-899-6167
Mailing Address - Fax:
Practice Address - Street 1:129 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1509
Practice Address - Country:US
Practice Address - Phone:801-899-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7416115-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical