Provider Demographics
NPI:1912069626
Name:LANEY, JOHN CLEMENS (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLEMENS
Last Name:LANEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W MARSHALL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-2741
Mailing Address - Country:US
Mailing Address - Phone:715-234-3301
Mailing Address - Fax:715-736-1301
Practice Address - Street 1:12 W MARSHALL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-2741
Practice Address - Country:US
Practice Address - Phone:715-234-3301
Practice Address - Fax:715-736-1301
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI514103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI29144OtherSECURITY HEALTH PLAN
WI39059400Medicaid
WI5066OtherMARSHFIELD CLINIC
WI81-285OtherWPS
WI39059400Medicare ID - Type Unspecified