Provider Demographics
NPI:1598060006
Name:GODAR, JENNIFER LORRAINE (PSYD, HSPP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:GODAR
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
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Mailing Address - Street 1:9102 N MERIDIAN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9102 N MERIDIAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1860
Practice Address - Country:US
Practice Address - Phone:317-574-1785
Practice Address - Fax:317-574-1786
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042481A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical