Provider Demographics
NPI:1043733751
Name:YIP, JANE ROEI
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ROEI
Last Name:YIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 3RD AVE SW STE 109
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7592
Mailing Address - Country:US
Mailing Address - Phone:317-503-1296
Mailing Address - Fax:317-853-6743
Practice Address - Street 1:1033 THIRD AVE SW, SUITE 109
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-503-1296
Practice Address - Fax:317-853-6743
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-17-25892103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194094110OtherGROUP NPI