Provider Demographics
NPI:1437356797
Name:BROCK, JANELLE KAY (MSW,LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:KAY
Last Name:BROCK
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:NE
Mailing Address - Zip Code:68865-1725
Mailing Address - Country:US
Mailing Address - Phone:308-382-3660
Mailing Address - Fax:308-385-2738
Practice Address - Street 1:2201 N BROADWELL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-2153
Practice Address - Country:US
Practice Address - Phone:308-382-3660
Practice Address - Fax:308-385-2738
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE663 AND 9731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical