Healthcare Provider Details

I. General information

NPI: 1184549859
Provider Name (Legal Business Name): JACQUELYNE ZAHNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W DUPONT RD
FORT WAYNE IN
46825-1915
US

IV. Provider business mailing address

900 AUTUMN HILLS DR LOT 60
AVILLA IN
46710-9413
US

V. Phone/Fax

Practice location:
  • Phone: 260-489-1774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: