Healthcare Provider Details

I. General information

NPI: 1396503090
Provider Name (Legal Business Name): KATELYNN JOINER BARRER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7951 STONEY BEND CT
INDIANAPOLIS IN
46259-6773
US

IV. Provider business mailing address

7951 STONEY BEND CT
INDIANAPOLIS IN
46259-6773
US

V. Phone/Fax

Practice location:
  • Phone: 803-606-2563
  • Fax:
Mailing address:
  • Phone: 803-606-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1319882
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.025682
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010988A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: