Provider Demographics
NPI:1558793620
Name:VERTHEIN, JANET LYNN (SAC, PS)
Entity Type:Individual
Prefix:MISS
First Name:JANET
Middle Name:LYNN
Last Name:VERTHEIN
Suffix:
Gender:F
Credentials:SAC, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7883 AMSTEL CT
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-7800
Mailing Address - Country:US
Mailing Address - Phone:608-386-7894
Mailing Address - Fax:
Practice Address - Street 1:9532 E 16 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-6739
Practice Address - Country:US
Practice Address - Phone:608-783-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15803-131101YA0400X
WI15345-137101YA0400X
WI15802-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)