Provider Demographics
NPI:1790798171
Name:ELLIOTT, JEANNETTE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2962
Mailing Address - Country:US
Mailing Address - Phone:219-934-9340
Mailing Address - Fax:219-924-9360
Practice Address - Street 1:9605 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2962
Practice Address - Country:US
Practice Address - Phone:219-934-9340
Practice Address - Fax:219-924-9360
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001779A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical