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General NPI Number Information
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NPI Number | 1629556535
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Entity Type | Individual
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Provider Name | JESSICAH DAWN WALKER HERCHE PHD, HSPP
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Gender | Female
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Dates
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Enumeration Date | 08/02/2018
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Last Update Date | 02/26/2022
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Provider Practice Location Address
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Address Line | 600 E CARMEL DR STE 263
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City | CARMEL
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State | IN
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Zip | 46032-3066
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Country | US
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Telephone | 317-747-0574
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Fax |
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Provider Business Mailing Address
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Address Line | 12550 CORDAY CT
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City | FISHERS
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State | IN
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Zip | 46038-1213
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Country | US
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Telephone | 317-747-0547
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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 | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 279-PY-PR-TEMP
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 20043217B
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License Number State | IN
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