Basic Information
Provider Information
NPI: 1801324348
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AHO
FirstName: JANICE
MiddleName: LYNNE
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6741 S IVY WAY APT A2
Address2:  
City: CENTENNIAL
State: CO
PostalCode: 801126299
CountryCode: US
TelephoneNumber: 6122194415
FaxNumber:  
Practice Location
Address1: 11059 E BETHANY DR
Address2:  
City: AURORA
State: CO
PostalCode: 800142622
CountryCode: US
TelephoneNumber: 3036172300
FaxNumber: 3036172365
Other Information
ProviderEnumerationDate: 05/29/2017
LastUpdateDate: 05/29/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X09924824COY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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