Provider Demographics
NPI:1912757691
Name:JANSKI, KELLIE (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:JANSKI
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10512 IRENE AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4739
Mailing Address - Country:US
Mailing Address - Phone:253-883-7004
Mailing Address - Fax:
Practice Address - Street 1:10512 IRENE AVE SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4739
Practice Address - Country:US
Practice Address - Phone:253-883-7004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61200021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical