Healthcare Provider Details

I. General information

NPI: 1356880686
Provider Name (Legal Business Name): JENNIFER PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 E CENTER STREET EXT
WARSAW IN
46582-3907
US

IV. Provider business mailing address

3201 E CENTER STREET EXT
WARSAW IN
46582-3907
US

V. Phone/Fax

Practice location:
  • Phone: 574-267-1700
  • Fax:
Mailing address:
  • Phone: 574-267-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33006501A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: