Basic Information
| Provider Information | |||||||||
| NPI: | 1225452238 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANKE | ||||||||
| FirstName: | PAUL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 W MAIN ST STE 3D | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975012744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417792393 | ||||||||
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| Practice Location | |||||||||
| Address1: | 695 MISTLETOE RD STE H | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975209552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414828906 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2014 | ||||||||
| LastUpdateDate: | 02/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 12-06-32 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.