Provider Demographics
NPI:1053536946
Name:JANKE, SCOTT (PSYD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:JANKE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W SAN ANTONIO ST
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-5549
Mailing Address - Country:US
Mailing Address - Phone:512-665-6586
Mailing Address - Fax:512-353-0540
Practice Address - Street 1:215 W SAN ANTONIO ST
Practice Address - Street 2:SUITE 2101
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5549
Practice Address - Country:US
Practice Address - Phone:512-665-6586
Practice Address - Fax:512-353-0540
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical