Provider Demographics
NPI:1013279835
Name:COLLINS, JEANIE HAN (MSA)
Entity type:Individual
Prefix:
First Name:JEANIE
Middle Name:HAN
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MSA
Other - Prefix:
Other - First Name:JEANIE
Other - Middle Name:YOUNGMEE
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSA
Mailing Address - Street 1:720 ESKENAZI AVENUE
Mailing Address - Street 2:FIFTH THIRD BANK BLDG., 5TH FLOOR
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5166
Mailing Address - Country:US
Mailing Address - Phone:317-670-4507
Mailing Address - Fax:317-880-0498
Practice Address - Street 1:720 ESKENAZI AVENUE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5166
Practice Address - Country:US
Practice Address - Phone:317-880-5542
Practice Address - Fax:317-554-2721
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker