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General NPI Number Information
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NPI Number | 1053960021
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Entity Type | Individual
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Provider Name | JESSICA SIMPSON PSYD HSPP
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Gender | Female
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 3700 W KILGORE AVE
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City | MUNCIE
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State | IN
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Zip | 47304-4810
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Country | US
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Telephone | 765-289-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 N RITTER AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-3026
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Country | US
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Telephone |
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20043572A
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License Number State | IN
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