Provider Demographics
NPI:1841772308
Name:VALLANCE, JANINE LYNN
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:LYNN
Last Name:VALLANCE
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 1:4341 S WESTNEDGE AVE STE 2212
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3287
Mailing Address - Country:US
Mailing Address - Phone:269-588-1441
Mailing Address - Fax:269-775-7551
Practice Address - Street 1:4341 S WESTNEDGE AVE STE 2212
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3287
Practice Address - Country:US
Practice Address - Phone:269-588-1441
Practice Address - Fax:269-775-7551
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty