Provider Demographics
NPI:1205505807
Name:WYNN, JANELLE (LSW)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:WYNN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5848
Mailing Address - Country:US
Mailing Address - Phone:856-723-2885
Mailing Address - Fax:
Practice Address - Street 1:3073 ENGLISH CREEK AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-9711
Practice Address - Country:US
Practice Address - Phone:609-569-0239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker