Janis M Pedro, LCSW
Individual provider Active NPI Behavior Technician · Laurel, MT
NPI 1104064195 · NPPES record last updated Aug 16, 2017
Key facts
- NPI
- 1104064195
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 20 5TH Ave
Laurel, MT 59044-2913 - Phone
- (307) 272-5881
- NPI assigned
- Jan 28, 2009
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 935 | MT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 935 | MT | |
| Clinical Social Worker | 1041C0700X | LCSW-524 | WY | |
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
20 5TH Ave
Laurel, MT 59044-2913
Mailing address
#20 5TH Avenue
Laurel, MT 59044-9299
Phone (307) 272-5881
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104064195 | Medicaid | MT |
Other providers in Laurel, MT
- Melissa Nieto
- Stephanie J Olsonawski
- Roy E. Pack Jr.
- Stacy Padden
- Paris PT & Associates LLC
- Debra Perrigo
- Pfaff Clinic of Chiropractic Inc
- Donna Jean Podolak
- Timothy Polacheck
- Sam R Pollock
All providers in Laurel, MT · Behavior Technician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.