Provider Demographics
NPI:1730704503
Name:JANIK, KATIE LYNN (MSW, APSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:JANIK
Suffix:
Gender:F
Credentials:MSW, APSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:ZACHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 KLEINE ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53531-9596
Mailing Address - Country:US
Mailing Address - Phone:414-430-0655
Mailing Address - Fax:
Practice Address - Street 1:5555 ODANA RD STE 202
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1280
Practice Address - Country:US
Practice Address - Phone:608-209-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131483-121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health