Provider Demographics
NPI:1861277204
Name:FELDEWERTH, JANEE
Entity type:Individual
Prefix:
First Name:JANEE
Middle Name:
Last Name:FELDEWERTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NORTHPORT PLZ
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-2269
Mailing Address - Country:US
Mailing Address - Phone:573-722-2209
Mailing Address - Fax:573-722-2209
Practice Address - Street 1:24 NORTHPORT PLZ
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-2269
Practice Address - Country:US
Practice Address - Phone:573-722-2209
Practice Address - Fax:573-722-2209
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1-23-67404103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst