Provider Demographics
NPI:1902995764
Name:JANKOWSKI, MARY LOUISE (LMHC, LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:JANKOWSKI
Suffix:
Gender:F
Credentials:LMHC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 34TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3128
Mailing Address - Country:US
Mailing Address - Phone:515-222-0950
Mailing Address - Fax:515-277-6995
Practice Address - Street 1:7405 UNIVERSITY AVE STE 6
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-1343
Practice Address - Country:US
Practice Address - Phone:515-277-1124
Practice Address - Fax:515-277-6995
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00253101YM0800X
IA03159104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker