Provider Demographics
NPI:1518240498
Name:JAHN, HEIDI M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:M
Last Name:JAHN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 W 10TH ST
Mailing Address - Street 2:ROOM A-1105 B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2803
Mailing Address - Country:US
Mailing Address - Phone:317-988-2243
Mailing Address - Fax:317-988-3678
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:A-1105 B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2243
Practice Address - Fax:317-988-3678
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006254A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical