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General NPI Number Information
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NPI Number | 1003318122
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Entity Type | Individual
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Provider Name | JEAN M NANOS PSY.D., HSPP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 8124 CALUMET AVE
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City | MUNSTER
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State | IN
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Zip | 46321
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Country | US
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Telephone | 219-852-8558
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Fax | 219-852-8558
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Provider Business Mailing Address
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Address Line | PO BOX 3294
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City | MUNSTER
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State | IN
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Zip | 46321-0294
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Country | US
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Telephone | 219-852-8558
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Fax | 219-852-8558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20043103A
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License Number State | IN
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