Healthcare Provider Details

I. General information

NPI: 1336012731
Provider Name (Legal Business Name): JENNIFER DANIELL, PHD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
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:
Mailing address:
  • Phone: 918-691-1609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER LYNN DANIELL
Title or Position: OWNER
Credential: PH.D.
Phone: 918-691-1609