Healthcare Provider Details

I. General information

NPI: 1336355528
Provider Name (Legal Business Name): JENNIFER MARIE WHALEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13061 NEW BRITTON DR
FISHERS IN
46038-1073
US

IV. Provider business mailing address

13061 NEW BRITTON DRIVE
FISHERS IN
46038
US

V. Phone/Fax

Practice location:
  • Phone: 317-408-3066
  • Fax: 317-585-0495
Mailing address:
  • Phone: 317-408-3066
  • Fax: 317-585-0495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34003072A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: