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15262 W 400 N Medaryville IN 47957-8107 | |
(219) 804-6262 | |
(877) 497-6001 |
Full Name | |
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Speciality | Social Worker |
Location | 15262 W 400 N, Medaryville, Indiana |
Authorized Official Name and Position | Jennifer Dyarman (DIRECTOR) |
Authorized Official Contact | 2604136994 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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417 W 81st Ave # 132 Merrillville IN 46410-5317 Ph: (219) 804-6262 | 15262 W 400 N Medaryville IN 47957-8107 Ph: (219) 804-6262 |
NPI Number | 1972106599 |
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Provider Enumeration Date | 11/17/2020 |
Last Update Date | 12/29/2024 |
Certification Date | 12/29/2024 |
Medicare PECOS PAC ID | 3476965070 |
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Medicare Enrollment ID | O20201223000380 |
Identifier | Type | State | Issuer |
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1972106599 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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104100000X | Social Worker | (* (Not Available)) | Primary |
Provider Name | Jennifer Dyarman |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1770873853 PECOS PAC ID: 1951677293 Enrollment ID: I20171101000338 |