Provider Demographics
NPI:1740648443
Name:JANIS, JASMINE (MSW, LISW-S, LICDC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:JANIS
Suffix:
Gender:F
Credentials:MSW, LISW-S, LICDC
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:
Other - Last Name:LAUTENSLAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LSW, CDCA
Mailing Address - Street 1:5665 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9122
Mailing Address - Country:US
Mailing Address - Phone:614-539-6427
Mailing Address - Fax:614-875-7843
Practice Address - Street 1:5665 HOOVER RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9122
Practice Address - Country:US
Practice Address - Phone:614-539-6427
Practice Address - Fax:614-875-7843
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHICDC.141143101YA0400X
OHI.0700185-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)