MEDICARE: JENNIFER HARDWICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	125-053989	IL

General Provider Information

NPI Number	:	1245492941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HARDWICK MD

Provider Business Mailing Address
First Line	:	415 N 26TH ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2895
Country	:	US
Telephone Number	:	765-446-6562
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 N 26TH ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2895
Country	:	US
Telephone Number	:	765-446-6562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	04/29/2021

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