Provider Demographics
NPI:1376699744
Name:VENAAS GILBRAITH, JANETTE ELIZABETH ANN
Entity Type:Individual
Prefix:MRS
First Name:JANETTE
Middle Name:ELIZABETH ANN
Last Name:VENAAS GILBRAITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10318 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8116
Mailing Address - Country:US
Mailing Address - Phone:701-238-3908
Mailing Address - Fax:701-232-2330
Practice Address - Street 1:10318 6TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8116
Practice Address - Country:US
Practice Address - Phone:701-238-3908
Practice Address - Fax:701-232-2330
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND528235Z00000X
MN7852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND55035Medicaid
ND4600911Medicare UPIN
ND55035Medicaid