Provider Demographics
NPI:1912241555
Name:JEPSEN, JANIS MICHELE (SPECIAL EDUCATION TE)
Entity type:Individual
Prefix:MS
First Name:JANIS
Middle Name:MICHELE
Last Name:JEPSEN
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION TE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3783 COUNTY HOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-8963
Mailing Address - Country:US
Mailing Address - Phone:315-719-3888
Mailing Address - Fax:
Practice Address - Street 1:417 LIBERTY STREET SUITE 2120
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527
Practice Address - Country:US
Practice Address - Phone:315-536-5160
Practice Address - Fax:315-536-5146
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist