Provider Demographics
NPI:1417209636
Name:KOSEK, JANINE RECORDS (LCSW)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:RECORDS
Last Name:KOSEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:ANN
Other - Last Name:RECORDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5175 SW HILLVIEW AVE APT B
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-3977
Mailing Address - Country:US
Mailing Address - Phone:541-224-6647
Mailing Address - Fax:866-316-9960
Practice Address - Street 1:5175 SW HILLVIEW AVE APT B
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-3977
Practice Address - Country:US
Practice Address - Phone:541-224-6647
Practice Address - Fax:866-316-9960
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL67911041C0700X
AZ177511041C0700X
FLSW 106471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical