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DR. JAN EARL WARNER PHD HSPP

Clinical Neuropsychologist

Mishawaka, Indiana

Provider NPI: 1043214679

Provider Information:
DR. JAN EARL WARNER PHD HSPP
Gender: M
Not Sole Proprietor

Practice Location:
230 E DAY RD STE 160  MISHAWAKA, IN 46545 US
Tel: 574-271-8222  Fax: 574-271-8896

Business Mailing Address:
230 E DAY RD #160 MISHAWAKA, IN 46545 US
Tel: 574-271-8222  Fax: 574-271-8896

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
IN20040740A
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
ININ20040740
N103TB0200XBehavioral Health & Social Service Providers
Psychologist
IN20040740A
Y103TC0700XBehavioral Health & Social Service Providers
Psychologist
IN20040740A

Other Provider Identifiers:

IssuerNumberStateType
100383350AIN05
BLUE CROSS BLUE SHIELD000000196536IN01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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