Provider Demographics
NPI:1346808730
Name:HEALY, JENNIFER R (LIFE COACH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:HEALY
Suffix:
Gender:F
Credentials:LIFE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1231
Mailing Address - Country:US
Mailing Address - Phone:812-435-5385
Mailing Address - Fax:812-435-6342
Practice Address - Street 1:420 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1231
Practice Address - Country:US
Practice Address - Phone:812-435-5385
Practice Address - Fax:812-435-6342
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN6694126174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100241710AMedicaid
IN100322900Medicaid