Provider Demographics
NPI:1295812469
Name:WILL, JANE A (PSYD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:WILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MANNHEIM RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-7965
Mailing Address - Country:US
Mailing Address - Phone:812-481-9988
Mailing Address - Fax:812-481-9989
Practice Address - Street 1:4201 MANNHEIM RD
Practice Address - Street 2:SUITE G
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-7965
Practice Address - Country:US
Practice Address - Phone:812-481-9988
Practice Address - Fax:812-481-9989
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040709103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00792Medicare UPIN
141640EMedicare PIN