Provider Demographics
NPI:1740428812
Name:THOMAS, JENNIFER M (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6202 CONSTITUTION DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1583
Mailing Address - Country:US
Mailing Address - Phone:260-226-6414
Mailing Address - Fax:260-459-6220
Practice Address - Street 1:6202 CONSTITUTION DR STE B
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1583
Practice Address - Country:US
Practice Address - Phone:260-226-6414
Practice Address - Fax:260-459-6220
Is Sole Proprietor?:No
Enumeration Date:2009-01-28
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health