Healthcare Provider Details

I. General information

NPI: 1740373869
Provider Name (Legal Business Name): JANE F. BECKER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E 10TH ST
FERDINAND IN
47532-9239
US

IV. Provider business mailing address

802 E 10TH ST
FERDINAND IN
47532-9239
US

V. Phone/Fax

Practice location:
  • Phone: 812-367-1411
  • Fax: 812-367-2313
Mailing address:
  • Phone: 812-367-1411
  • Fax: 812-367-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20010259A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: