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NPI Code Detail

MEDICARE: JON D SHARPE

MEDICARE: JON D SHARPE
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1457013419
Entity Type Code : Organization
Provider Name (Legal Business Name) : JON D SHARPE
Provider Business Mailing Address
First Line : 4656 W JEFFERSON BLVD STE 285
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6838
Country : US
Telephone Number : 260-422-9372
Fax Number : 260-422-0843
Provider Business Practice Location Address
First Line : 4656 W JEFFERSON BLVD STE 285
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6838
Country : US
Telephone Number : 260-422-9372
Fax Number : 260-422-0843
Authorized Official
Title or Position : OWNER
Name : JON D SHARPE
Credential : LCSW
Telephone Number : 260-422-9372
Provider Enumeration Date : 10/07/2021
Last Update Date : 10/07/2021

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Directions to “JON D SHARPE ” Practice Location

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