Basic Information
| Provider Information | |||||||||
| NPI: | 1922138478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LODAHL | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN, BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6747 FRAIRS RD | ||||||||
| Address2: | APT 97 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192262111 | ||||||||
| FaxNumber: | 6192660496 | ||||||||
| Practice Location | |||||||||
| Address1: | 286 EUCLID AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192662111 | ||||||||
| FaxNumber: | 6192660496 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.