Provider Demographics
NPI:1942297882
Name:NIX, JANET L (PHD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:NIX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:L
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:202 PHOENIX ST NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4850
Mailing Address - Country:US
Mailing Address - Phone:360-705-1675
Mailing Address - Fax:
Practice Address - Street 1:202 PHOENIX ST NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4850
Practice Address - Country:US
Practice Address - Phone:360-705-1675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0001046103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001002411Medicare PIN