Provider Demographics
NPI:1649344888
Name:MERTEN, JANICE M (MSW MA)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:M
Last Name:MERTEN
Suffix:
Gender:F
Credentials:MSW MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1923 KAAT LN
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-9104
Mailing Address - Country:US
Mailing Address - Phone:920-980-6808
Mailing Address - Fax:920-783-8004
Practice Address - Street 1:1923 KAAT LN
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-9104
Practice Address - Country:US
Practice Address - Phone:920-980-6808
Practice Address - Fax:920-783-8004
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490073831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649344888OtherHEALTH INSURANCE COMPANIES