Provider Demographics
NPI:1588138192
Name:KLEPACKI, JANETTE
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:
Last Name:KLEPACKI
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 1:751 EAST GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388
Mailing Address - Country:US
Mailing Address - Phone:864-476-7400
Mailing Address - Fax:
Practice Address - Street 1:2801 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4101
Practice Address - Country:US
Practice Address - Phone:732-770-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0-18-9111106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst