Provider Demographics
NPI:1497957724
Name:VANNIEL, JANICE ALBERDIENA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:ALBERDIENA
Last Name:VANNIEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-5913
Mailing Address - Country:US
Mailing Address - Phone:262-656-1531
Mailing Address - Fax:262-654-2031
Practice Address - Street 1:7807 15TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-5913
Practice Address - Country:US
Practice Address - Phone:262-656-1531
Practice Address - Fax:262-654-2031
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1777-057103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42444OtherNATIONAL REGISTER
WI3568OtherCPQ-ASPPB
WI3568OtherCPQ-ASPPB