Provider Demographics
NPI:1871712422
Name:FRANKENBERGER, JAN DANIEL (RRW)
Entity type:Individual
Prefix:MR
First Name:JAN
Middle Name:DANIEL
Last Name:FRANKENBERGER
Suffix:
Gender:M
Credentials:RRW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 ZION ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2920
Mailing Address - Country:US
Mailing Address - Phone:530-265-2941
Mailing Address - Fax:530-265-2974
Practice Address - Street 1:727 ZION ST
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2920
Practice Address - Country:US
Practice Address - Phone:530-265-2941
Practice Address - Fax:530-265-2974
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290007AP101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)