Provider Demographics
NPI:1982953576
Name:WEST, JANETTE (SW)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:JANETTE
Other - Middle Name:PATRICIA
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:4341 N 90TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1601
Mailing Address - Country:US
Mailing Address - Phone:414-231-4000
Mailing Address - Fax:
Practice Address - Street 1:4341 N 90TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1601
Practice Address - Country:US
Practice Address - Phone:414-231-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5902-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIJPC1217Medicaid