Provider Demographics
NPI:1346373891
Name:MANSKER WEBB, JANET L (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:MANSKER WEBB
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11470 SUMMERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:IL
Mailing Address - Zip Code:62286-3670
Mailing Address - Country:US
Mailing Address - Phone:618-443-2100
Mailing Address - Fax:618-443-1080
Practice Address - Street 1:11470 SUMMERVILLE RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:IL
Practice Address - Zip Code:62286-3670
Practice Address - Country:US
Practice Address - Phone:618-443-2100
Practice Address - Fax:618-443-1080
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20-3149526OtherTAX ID #