Healthcare Provider Details

I. General information

NPI: 1407650120
Provider Name (Legal Business Name): CLARISSE O SODJINOU PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8398 MISSISSIPPI ST FL 2
MERRILLVILLE IN
46410-6316
US

IV. Provider business mailing address

8398 MISSISSIPPI ST FL 2
MERRILLVILLE IN
46410-6316
US

V. Phone/Fax

Practice location:
  • Phone: 855-743-2247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71018522A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: