Provider Demographics
NPI:1497273015
Name:CHAN, JANA B (PHD)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:B
Last Name:CHAN
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:B
Other - Last Name:DYKSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 W 16TH STREET GOODMAN HALL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-963-7328
Practice Address - Fax:317-963-7313
Is Sole Proprietor?:No
Enumeration Date:2017-09-04
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043084A103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001115087OtherANTHEM PTAN
IN300006445Medicaid
IN000001115087OtherANTHEM PTAN