MEDICARE: JILL IRWIN

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	103TS0200X	School Psychologist	1555896	IN

General Provider Information

NPI Number	:	1922825298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL IRWIN

Provider Business Mailing Address
First Line	:	1900 E STOP 12 RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6232
Country	:	US
Telephone Number	:	317-789-2737
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 E STOP 12 RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6232
Country	:	US
Telephone Number	:	317-789-2737
Fax Number	:

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

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	09/26/2024

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Directions to “ JILL IRWIN ” Practice Location

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