Healthcare Provider Details

I. General information

NPI: 1821250804
Provider Name (Legal Business Name): JPM THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 SUDA DR
INDIANAPOLIS IN
46280-1571
US

IV. Provider business mailing address

2052 SUDA DR
INDIANAPOLIS IN
46280-1571
US

V. Phone/Fax

Practice location:
  • Phone: 317-571-8595
  • Fax: 317-571-8595
Mailing address:
  • Phone: 317-571-8595
  • Fax: 317-571-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22004529A
License Number StateIN

VIII. Authorized Official

Name: MRS. JACQUELINE PATRICIA MCNULTY
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MA, CCC-SLP
Phone: 317-571-8595