Provider Demographics
NPI:1740373869
Name:BECKER, JANE F (PHD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:F
Last Name:BECKER
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 1:802 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:FERDINAND
Mailing Address - State:IN
Mailing Address - Zip Code:47532-9239
Mailing Address - Country:US
Mailing Address - Phone:812-367-1411
Mailing Address - Fax:812-367-2313
Practice Address - Street 1:802 E 10TH ST
Practice Address - Street 2:
Practice Address - City:FERDINAND
Practice Address - State:IN
Practice Address - Zip Code:47532-9239
Practice Address - Country:US
Practice Address - Phone:812-367-1411
Practice Address - Fax:812-367-2313
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20010259A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN212210DMedicare ID - Type UnspecifiedMEDICARE