Provider Demographics
NPI:1124140942
Name:JANZ, DENNICE YAVONNE (MFT)
Entity type:Individual
Prefix:
First Name:DENNICE
Middle Name:YAVONNE
Last Name:JANZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:DENNICE
Other - Middle Name:YAVONNE
Other - Last Name:CAVANAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1738 BRACKETT AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4626
Mailing Address - Country:US
Mailing Address - Phone:715-450-2465
Mailing Address - Fax:
Practice Address - Street 1:1738 BRACKETT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4626
Practice Address - Country:US
Practice Address - Phone:715-450-2465
Practice Address - Fax:715-514-2116
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43706500Medicaid