Provider Demographics
NPI:1144910811
Name:JANECEK, JUSTINE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:JANECEK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:
Other - Last Name:SCHUMACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3060 FRONTIER WAY S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8909
Mailing Address - Country:US
Mailing Address - Phone:701-232-2340
Mailing Address - Fax:701-232-2330
Practice Address - Street 1:310 RED LAKE BLVD
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-2133
Practice Address - Country:US
Practice Address - Phone:218-416-1482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7515235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist