Provider Demographics
NPI:1578693156
Name:FORD, JANE ANNE RUSH (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ANNE RUSH
Last Name:FORD
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:A
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, HSPP
Mailing Address - Street 1:4740 KINGSWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1521
Mailing Address - Country:US
Mailing Address - Phone:317-466-1000
Mailing Address - Fax:317-466-2000
Practice Address - Street 1:4740 KINGSWAY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1521
Practice Address - Country:US
Practice Address - Phone:317-466-1000
Practice Address - Fax:317-466-1000
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043443A103TC0700X, 103TM1800X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities