MEDICARE: MRS. JANET L. DAVIDSON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	C2-1927	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C2-1927	OTHER	IN	ICAADA

General Provider Information

NPI Number	:	1578280715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET L. DAVIDSON

Provider Business Mailing Address
First Line	:	3560 KESSLER BLVD NORTH DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-5801
Country	:	US
Telephone Number	:	317-750-5011
Fax Number	:

Provider Business Practice Location Address
First Line	:	3560 KESSLER BLVD NORTH DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-5801
Country	:	US
Telephone Number	:	317-750-5011
Fax Number	:

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

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	10/27/2022

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