Healthcare Provider Details

I. General information

NPI: 1225130495
Provider Name (Legal Business Name): JENNIFER LYNN DANIELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 N PARK AVE
INDIANAPOLIS IN
46205-1063
US

IV. Provider business mailing address

5035 N PARK AVE
INDIANAPOLIS IN
46205-1063
US

V. Phone/Fax

Practice location:
  • Phone: 918-691-1609
  • Fax: 999-999-9999
Mailing address:
  • Phone: 918-691-1609
  • Fax: 999-999-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number652
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: