Provider Demographics
NPI:1386369783
Name:JANKE, KIMBERLY ANN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:JANKE
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 1:65 SW YAMHILL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3316
Mailing Address - Country:US
Mailing Address - Phone:503-523-0296
Mailing Address - Fax:503-523-0296
Practice Address - Street 1:65 SW YAMHILL ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3316
Practice Address - Country:US
Practice Address - Phone:503-878-8885
Practice Address - Fax:971-297-1360
Is Sole Proprietor?:No
Enumeration Date:2022-10-07
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC615573021041C0700X
ORA153061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical