Provider Demographics
NPI:1841414133
Name:DE WALD, JANET
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:DE WALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15013 LEASOWE LN
Mailing Address - Street 2:
Mailing Address - City:GUERNEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95446-9763
Mailing Address - Country:US
Mailing Address - Phone:707-869-3531
Mailing Address - Fax:
Practice Address - Street 1:19375 HIGHWAY 116
Practice Address - Street 2:
Practice Address - City:MONTE RIO
Practice Address - State:CA
Practice Address - Zip Code:95462-0519
Practice Address - Country:US
Practice Address - Phone:707-865-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor