Provider Demographics
NPI:1023231198
Name:LE SUER, JEANNA (MS)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:LE SUER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JEANNA
Other - Middle Name:
Other - Last Name:LE SUER-MANDERNACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMFT, LCAC
Mailing Address - Street 1:240 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3988
Mailing Address - Country:US
Mailing Address - Phone:765-254-5133
Mailing Address - Fax:
Practice Address - Street 1:424 E SOUTHWAY BLVD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3814
Practice Address - Country:US
Practice Address - Phone:765-480-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN106H00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)