Provider Demographics
NPI:1871510628
Name:ENGSTROM, JANELLE LEIGH (LISW)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:LEIGH
Last Name:ENGSTROM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-9304
Mailing Address - Country:US
Mailing Address - Phone:612-750-4027
Mailing Address - Fax:319-433-3870
Practice Address - Street 1:530 SIERRA DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-9304
Practice Address - Country:US
Practice Address - Phone:612-750-4027
Practice Address - Fax:319-433-3870
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006997101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
207414OtherMEDICARE GROUP NO.
K26200Medicare ID - Type Unspecified