Provider Demographics
NPI:1487383279
Name:JANAKY, JACQUELYN LEIGH
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:LEIGH
Last Name:JANAKY
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:N2419 MARIONDALE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-9011
Mailing Address - Country:US
Mailing Address - Phone:815-219-8880
Mailing Address - Fax:
Practice Address - Street 1:753 GENEVAPKWY N
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147
Practice Address - Country:US
Practice Address - Phone:262-217-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI532-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst