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NPI Code Detail

MEDICARE: JENNIFER SIMMONS

MEDICARE: JENNIFER SIMMONS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TF0000XFamily Psychologist20042826AIN

General Provider Information

NPI Number : 1356838064
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER SIMMONS
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number : 317-678-3850
Fax Number : 317-968-1142
Provider Business Practice Location Address
First Line : 11530 ALLISONVILLE RD STE 190
Second Line :
City : FISHERS
State : IN
Zip : 46038-1862
Country : US
Telephone Number : 317-678-3850
Fax Number : 317-968-1142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2018
Last Update Date : 11/16/2020

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