Healthcare Provider Details

I. General information

NPI: 1770911687
Provider Name (Legal Business Name): JENNIFER L. NORRIS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L DAUGHERTY

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR RI 3038C
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

PO BOX 1026 INDIANAPOLIS
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-2617
  • Fax: 317-274-2587
Mailing address:
  • Phone: 317-278-9922
  • Fax: 317-278-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33006791
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: