Provider Demographics
NPI:1629556535
Name:WALKER HERCHE, JESSICAH DAWN (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:JESSICAH
Middle Name:DAWN
Last Name:WALKER HERCHE
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 CORDAY CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1213
Mailing Address - Country:US
Mailing Address - Phone:317-747-0547
Mailing Address - Fax:
Practice Address - Street 1:600 E CARMEL DR STE 263
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3066
Practice Address - Country:US
Practice Address - Phone:317-747-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2022-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA279-PY-PR-TEMP103TH0100X
IN20043217B103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service