Provider Demographics
NPI:1932157310
Name:JANSEN, GINA MAUREEN (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MAUREEN
Last Name:JANSEN
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 UNION ST
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-1719
Mailing Address - Country:US
Mailing Address - Phone:641-620-5058
Mailing Address - Fax:641-620-5080
Practice Address - Street 1:505 UNION ST
Practice Address - Street 2:
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1719
Practice Address - Country:US
Practice Address - Phone:641-620-5058
Practice Address - Fax:641-620-5080
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04768104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04768OtherLICENSE