Provider Demographics
NPI:1679582753
Name:JANZEN, RANDY SHANE (LSCW)
Entity Type:Individual
Prefix:MS
First Name:RANDY
Middle Name:SHANE
Last Name:JANZEN
Suffix:
Gender:F
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-7057
Mailing Address - Country:US
Mailing Address - Phone:559-323-5547
Mailing Address - Fax:559-299-5025
Practice Address - Street 1:4828 N 1ST ST
Practice Address - Street 2:SUITE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0528
Practice Address - Country:US
Practice Address - Phone:559-299-5025
Practice Address - Fax:559-299-5025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS119551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical