Healthcare Provider Details

I. General information

NPI: 1285137463
Provider Name (Legal Business Name): JESSICA ROLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6067 DECATUR BLVD
INDIANAPOLIS IN
46241-9606
US

IV. Provider business mailing address

5926 MENDENHALL RD
INDIANAPOLIS IN
46221-4424
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5201
  • Fax:
Mailing address:
  • Phone: 317-319-1545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48994
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: