Provider Demographics
NPI:1841581816
Name:REKEDAL, JANNA RAE (MSW)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:RAE
Last Name:REKEDAL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:RAE
Other - Last Name:FOSTERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1614 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-2094
Mailing Address - Country:US
Mailing Address - Phone:715-977-1739
Mailing Address - Fax:
Practice Address - Street 1:235 W 7TH ST
Practice Address - Street 2:
Practice Address - City:JUNCTION CITY
Practice Address - State:KS
Practice Address - Zip Code:66441-3594
Practice Address - Country:US
Practice Address - Phone:785-762-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7955104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker