Provider Demographics
NPI:1952737314
Name:JANKE, MARY SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUZANNE
Last Name:JANKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12932 DESPLAINES DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7827
Mailing Address - Country:US
Mailing Address - Phone:317-407-8198
Mailing Address - Fax:
Practice Address - Street 1:3940 E 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-5963
Practice Address - Country:US
Practice Address - Phone:317-396-0683
Practice Address - Fax:317-396-0687
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004322A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical