Provider Demographics
NPI:1417180183
Name:BOODRO, JENNIFER T (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:T
Last Name:BOODRO
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 1:7850 RIDGELAND DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2269
Mailing Address - Country:US
Mailing Address - Phone:317-771-2077
Mailing Address - Fax:
Practice Address - Street 1:7850 RIDGELAND DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2269
Practice Address - Country:US
Practice Address - Phone:317-771-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist