Provider Demographics
NPI:1700090677
Name:KNAPP, JENNIFER S (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:S
Last Name:KNAPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:S
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3220 E JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-3028
Mailing Address - Country:US
Mailing Address - Phone:574-222-2466
Mailing Address - Fax:574-222-2468
Practice Address - Street 1:3220 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-3028
Practice Address - Country:US
Practice Address - Phone:574-222-2466
Practice Address - Fax:574-222-2468
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0096592084P0800X
IN02003907A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN02003907AOtherOSTEOPATH PHYSICIAN LICENSE
IN000000727514OtherANTHEM
IN201032160Medicaid
IN201032160Medicaid
INM400054292Medicare PIN