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NPI Code Detail

MEDICARE: JODY WATSON TUCKER

MEDICARE: JODY WATSON TUCKER
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
11041C0700XClinical Social Worker34004435AIN

General Provider Information

NPI Number : 1588637581
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODY WATSON TUCKER
Provider Business Mailing Address
First Line : 618 N HIGH SCHOOL RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46214-3684
Country : US
Telephone Number : 317-381-0355
Fax Number : 317-381-0356
Provider Business Practice Location Address
First Line : 618 N HIGH SCHOOL RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46214-3684
Country : US
Telephone Number : 317-381-0355
Fax Number : 317-381-0356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 11/22/2021

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