Provider Demographics
NPI:1376696344
Name:FANSLOW, JANE ELLEN (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELLEN
Last Name:FANSLOW
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:2501 OREGON PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4890
Practice Address - Country:US
Practice Address - Phone:717-735-1954
Practice Address - Fax:717-569-3045
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1875101YP2500X
VA0701006088101YP2500X
PAPC009613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103757465Medicaid
10751861OtherCAQH