Provider Demographics
NPI:1750781019
Name:WEAVER, JANET HUDSON
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:HUDSON
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15661 BETHPAGE TRL
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-5510
Mailing Address - Country:US
Mailing Address - Phone:765-860-2766
Mailing Address - Fax:
Practice Address - Street 1:194 E SOUTHWAY BLVD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3650
Practice Address - Country:US
Practice Address - Phone:765-450-4843
Practice Address - Fax:765-450-4895
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist