Provider Demographics
NPI:1265241145
Name:JANER, MEGHAN KELLEY
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KELLEY
Last Name:JANER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9640 401ST AVE
Mailing Address - Street 2:
Mailing Address - City:GENOA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53128-2217
Mailing Address - Country:US
Mailing Address - Phone:713-805-9729
Mailing Address - Fax:
Practice Address - Street 1:1400 75TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-1544
Practice Address - Country:US
Practice Address - Phone:262-909-6008
Practice Address - Fax:262-764-8048
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20642130101YA0400X
WI8272226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)