Provider Demographics
NPI:1093774630
Name:CUMMINGS, JENNIFER LYNN (CP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:CP
Other - Prefix:DR
Other - First Name:JENNINFER
Other - Middle Name:SMITH
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD HSPP
Mailing Address - Street 1:230 E DAY RD
Mailing Address - Street 2:#160
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3463
Mailing Address - Country:US
Mailing Address - Phone:574-271-8222
Mailing Address - Fax:574-271-8896
Practice Address - Street 1:230 E DAY RD STE 160
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3463
Practice Address - Country:US
Practice Address - Phone:574-271-8222
Practice Address - Fax:574-271-8896
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041170103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000382360OtherBCBS PROVIDER NUMBER
IN100091430AMedicaid