Healthcare Provider Details

I. General information

NPI: 1801611736
Provider Name (Legal Business Name): JEANNE WITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 S HARBOUR DR
NOBLESVILLE IN
46062-9527
US

IV. Provider business mailing address

595 S HARBOUR DR
NOBLESVILLE IN
46062-9527
US

V. Phone/Fax

Practice location:
  • Phone: 317-674-5200
  • Fax:
Mailing address:
  • Phone: 317-674-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1617869
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: