Provider Demographics
NPI:1811551138
Name:JANIKOWSKI, JEFFREY LEE (CSAC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:JANIKOWSKI
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 STATE ROAD 67
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-1650
Mailing Address - Country:US
Mailing Address - Phone:920-797-4419
Mailing Address - Fax:920-894-4471
Practice Address - Street 1:13111 LAX CHAPEL RD
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-3954
Practice Address - Country:US
Practice Address - Phone:920-797-4419
Practice Address - Fax:920-894-4471
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16244-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)