Provider Demographics
NPI:1861477556
Name:POHANKA, JANET MADELEINE (LCSW)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MADELEINE
Last Name:POHANKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E 3900 S STE A170
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1250
Mailing Address - Country:US
Mailing Address - Phone:801-284-4990
Mailing Address - Fax:
Practice Address - Street 1:1141 E 3900 S STE A170
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1250
Practice Address - Country:US
Practice Address - Phone:801-284-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT132557-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT261927OtherDESERET MUTUAL
UT942938348P01OtherEDUCATOR'S MUTUAL
UT005739004OtherRAILROAD MEDICARE
UT107001390101OtherINTERMTN HEALTH CARE
UT942938348002OtherCHAMPUS
UT004662095Medicare PIN
UT942938348002OtherCHAMPUS
UT261927OtherDESERET MUTUAL