Provider Demographics
NPI:1114633427
Name:BUCHANAN, JESSICA B
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:B
Last Name:BUCHANAN
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:PO BOX 1676
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-1676
Mailing Address - Country:US
Mailing Address - Phone:765-287-3087
Mailing Address - Fax:765-213-2769
Practice Address - Street 1:333 S MADISON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-2465
Practice Address - Country:US
Practice Address - Phone:765-286-7000
Practice Address - Fax:765-213-2768
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010515A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker