Provider Demographics
NPI:1104614072
Name:DWYER, VENESSA
Entity type:Individual
Prefix:
First Name:VENESSA
Middle Name:
Last Name:DWYER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:VENESSA
Other - Middle Name:
Other - Last Name:SEBEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9559 W CAMPFIRE DR
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-9473
Mailing Address - Country:US
Mailing Address - Phone:859-358-6523
Mailing Address - Fax:
Practice Address - Street 1:1806 SR 234
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040
Practice Address - Country:US
Practice Address - Phone:317-485-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician