Provider Demographics
NPI:1710125851
Name:SHEPARD, JENNA H (PHD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:H
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:M
Other - Last Name:HARMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7900 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4128
Mailing Address - Country:US
Mailing Address - Phone:260-435-6200
Mailing Address - Fax:260-435-6201
Practice Address - Street 1:7900 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4128
Practice Address - Country:US
Practice Address - Phone:260-435-6200
Practice Address - Fax:260-435-6201
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ PROCESS103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist