Healthcare Provider Details

I. General information

NPI: 1386577757
Provider Name (Legal Business Name): JALA SANAA WEBSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 W BETHEL AVE
MUNCIE IN
47304-5467
US

IV. Provider business mailing address

1410 W WHITE RIVER BLVD APT 14
MUNCIE IN
47303-4972
US

V. Phone/Fax

Practice location:
  • Phone: 765-282-8222
  • Fax: 765-282-8222
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: