Provider Demographics
NPI:1912269671
Name:JANSA, VIRGINIA KATHLENE
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:KATHLENE
Last Name:JANSA
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 1:8009 MANOR DR NE
Mailing Address - Street 2:
Mailing Address - City:LANESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47136-8741
Mailing Address - Country:US
Mailing Address - Phone:812-952-1741
Mailing Address - Fax:
Practice Address - Street 1:8009 MANOR DR NE
Practice Address - Street 2:
Practice Address - City:LANESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47136-8741
Practice Address - Country:US
Practice Address - Phone:812-952-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst