Healthcare Provider Details

I. General information

NPI: 1750781019
Provider Name (Legal Business Name): JANET HUDSON WEAVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 E SOUTHWAY BLVD
KOKOMO IN
46902-3650
US

IV. Provider business mailing address

15661 BETHPAGE TRL
CARMEL IN
46033-5510
US

V. Phone/Fax

Practice location:
  • Phone: 765-450-4843
  • Fax: 765-450-4895
Mailing address:
  • Phone: 765-860-2766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001045
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: