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NPI Code Detail

MEDICARE: MISS JENNIFER LEA DISBRO MSW

MEDICARE: MISS JENNIFER LEA DISBRO MSW
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 : 1922282433
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JENNIFER LEA DISBRO MSW
Provider Business Mailing Address
First Line : 618 N HIGH SCHOOL RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46214-3684
Country : US
Telephone Number : 317-271-3500
Fax Number :
Provider Business Practice Location Address
First Line : 618 N HIGH SCHOOL RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46214-3684
Country : US
Telephone Number : 317-271-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2007
Last Update Date : 12/19/2007

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