Healthcare Provider Details

I. General information

NPI: 1750316766
Provider Name (Legal Business Name): JENNIFER C SLOAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 E MAIN ST
GREENWOOD IN
46143-1407
US

IV. Provider business mailing address

4909 N MERIDIAN ST
INDIANAPOLIS IN
46208-2621
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-1348
  • Fax: 317-888-1104
Mailing address:
  • Phone: 317-887-1348
  • Fax: 317-888-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01056792
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: