MEDICARE: DR. JACQUELINE LEWIS HESS PSY.D.

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	103TC0700X	Clinical Psychologist	20040850	IN

General Provider Information

NPI Number	:	1487700639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE LEWIS HESS PSY.D.

Provider Business Mailing Address
First Line	:	9240 N MERIDIAN ST
Second Line	:	STE 320
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1822
Country	:	US
Telephone Number	:	317-574-1785
Fax Number	:	317-574-1786

Provider Business Practice Location Address
First Line	:	201 W 103RD ST
Second Line	:	SUITE 280
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1087
Country	:	US
Telephone Number	:	317-574-1785
Fax Number	:	317-574-1786

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

Provider Enumeration Date	:	01/27/2007
Last Update Date	:	05/30/2019

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