Provider Demographics
NPI:1821174616
Name:JANZEN, GLENDA MAE (LICSW)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:MAE
Last Name:JANZEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2615
Mailing Address - Country:US
Mailing Address - Phone:651-772-5568
Mailing Address - Fax:651-772-5656
Practice Address - Street 1:1165 ARCADE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2615
Practice Address - Country:US
Practice Address - Phone:651-772-5568
Practice Address - Fax:651-772-5656
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNNA431104226OtherPREFFERED ONE
MN323P9JAOtherBCBS
MNHP29342OtherHEALTH PARTNERS
MN121386P051OtherUCARE
MN367155100Medicaid
MN6267201OtherMEDICA