Provider Demographics
NPI:1053730366
Name:AUSTIN, JANAE JUSTINE
Entity type:Individual
Prefix:MS
First Name:JANAE
Middle Name:JUSTINE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11042 RUSTY RAY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-7815
Mailing Address - Country:US
Mailing Address - Phone:702-277-7217
Mailing Address - Fax:
Practice Address - Street 1:6345 S JONES BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3334
Practice Address - Country:US
Practice Address - Phone:702-515-4009
Practice Address - Fax:702-553-3438
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-2533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist