Provider Demographics
NPI:1124421839
Name:JANKOWSKI, JUDITH LYNN
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN
Last Name:JANKOWSKI
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 1:243 E BLACKSTOCK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-2653
Mailing Address - Country:US
Mailing Address - Phone:864-764-2151
Mailing Address - Fax:864-586-2300
Practice Address - Street 1:243 E BLACKSTOCK RD STE 3
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2653
Practice Address - Country:US
Practice Address - Phone:864-764-2151
Practice Address - Fax:864-586-2300
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SC6473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor