Provider Demographics
NPI:1659515310
Name:JANECKE, JILL L (MS, LPC-MH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:L
Last Name:JANECKE
Suffix:
Gender:F
Credentials:MS, LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-4520
Mailing Address - Country:US
Mailing Address - Phone:605-494-1500
Mailing Address - Fax:605-494-1501
Practice Address - Street 1:2214 LEVEE ST
Practice Address - Street 2:
Practice Address - City:FORT PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57532-2282
Practice Address - Country:US
Practice Address - Phone:605-691-5825
Practice Address - Fax:605-494-1501
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-26
Last Update Date:2017-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health