Provider Demographics
NPI:1679771224
Name:WANLASS, JANINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:WANLASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3810
Mailing Address - Country:US
Mailing Address - Phone:801-487-4403
Mailing Address - Fax:
Practice Address - Street 1:350 S 400 E
Practice Address - Street 2:SUITE 121E
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2908
Practice Address - Country:US
Practice Address - Phone:801-328-9204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT363402-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling