Provider Demographics
NPI:1104601053
Name:BURKES, JANIYA
Entity type:Individual
Prefix:
First Name:JANIYA
Middle Name:
Last Name:BURKES
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 1:1841 WOODS HOLE RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2182
Mailing Address - Country:US
Mailing Address - Phone:419-705-8650
Mailing Address - Fax:
Practice Address - Street 1:2400 N REYNOLDS RD STE A
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2833
Practice Address - Country:US
Practice Address - Phone:567-249-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator