| Entity Name: | JAN ICE, MSW, LCSW, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Jul 2004 (21 years ago) |
| Document Number: | P04000101313 |
| FEI/EIN Number | 020726997 |
| Address: | 4521 BROADWAY AVE W, ESTERO, FL, 33928, US |
| Mail Address: | 4521 BROADWAY AVE W, ESTERO, FL, 33928, US |
| ZIP code: | 33928 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033364039 | 2008-11-19 | 2009-03-14 | 4521 BROADWAY AVE W, ESTERO, FL, 339282624, US | 1415 PANTHER LN, SUITE 215, NAPLES, FL, 341097874, US | |||||||||||||||||||
|
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| Phone | +1 239-591-6626 |
| Fax | 2395916627 |
Authorized person
| Name | MS. JAN ICE |
| Role | PSYCHOTHERAPIST |
| Phone | 2392733915 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW5007 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Barletta Jan I | Agent | 4521 BROADWAY AVE W, ESTERO, FL, 33928 |
| Name | Role | Address |
|---|---|---|
| ICE JAN | President | 4521 BROADWAY WEST, ESTERO, FL, 33928 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-29 | 4521 BROADWAY AVE W, ESTERO, FL 33928 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-29 | 4521 BROADWAY AVE W, ESTERO, FL 33928 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-29 | 4521 BROADWAY AVE W, ESTERO, FL 33928 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-03-24 | Barletta, Jan I | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-15 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-03-28 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-02-18 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-03-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
