Provider Demographics
NPI:1033245592
Name:BADRY, JEAN MUREE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MUREE
Last Name:BADRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-1230
Mailing Address - Country:US
Mailing Address - Phone:765-472-3407
Mailing Address - Fax:
Practice Address - Street 1:255 N MIAMI ST
Practice Address - Street 2:BOWEN CENTER FOR HUMAN SERVICES
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992
Practice Address - Country:US
Practice Address - Phone:260-563-8446
Practice Address - Fax:260-563-1902
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042152A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5107481BADOtherBCBS
AL74841Medicaid
R63322Medicare UPIN
33830Medicare ID - Type Unspecified