Provider Demographics
NPI:1184807141
Name:JANSKY, JOHN LARRY (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LARRY
Last Name:JANSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2846 STATE ROAD 67
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS BAY
Mailing Address - State:WI
Mailing Address - Zip Code:53191-3771
Mailing Address - Country:US
Mailing Address - Phone:262-245-5608
Mailing Address - Fax:262-245-5648
Practice Address - Street 1:N2846 STATE ROAD 67
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-3771
Practice Address - Country:US
Practice Address - Phone:262-245-5608
Practice Address - Fax:262-245-5648
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI856-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical