Provider Demographics
NPI:1750682068
Name:MYNATT, JANIE MARIE (MSSW LISW-S)
Entity Type:Individual
Prefix:MS
First Name:JANIE
Middle Name:MARIE
Last Name:MYNATT
Suffix:
Gender:F
Credentials:MSSW LISW-S
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:MYNATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSSW LISW-S
Mailing Address - Street 1:1719 WOODBURN AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-2951
Mailing Address - Country:US
Mailing Address - Phone:859-291-9990
Mailing Address - Fax:
Practice Address - Street 1:1719 WOODBURN AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-2951
Practice Address - Country:US
Practice Address - Phone:859-291-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0010042-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical