Provider Demographics
NPI:1801218698
Name:MARTENSEN, JANICE MADDISON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:MADDISON
Last Name:MARTENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JANICE
Other - Middle Name:MADDISON
Other - Last Name:FILLMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1571 S 400 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-8304
Mailing Address - Country:US
Mailing Address - Phone:801-885-0903
Mailing Address - Fax:
Practice Address - Street 1:51 E 800 N
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-1210
Practice Address - Country:US
Practice Address - Phone:435-314-9623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
UT10493826-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT84-2224657Medicaid