Provider Demographics
NPI:1861575474
Name:JANZEN, JULIE L (LCSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:JANZEN
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:PO BOX 49
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-0049
Mailing Address - Country:US
Mailing Address - Phone:417-326-7272
Mailing Address - Fax:417-326-2193
Practice Address - Street 1:714 N POMME DE TERRE AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-1241
Practice Address - Country:US
Practice Address - Phone:417-326-7272
Practice Address - Fax:471-326-2193
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060161271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006016127OtherMO STATE LICENSE