Provider Demographics
NPI:1548214968
Name:DICKENS, JEANNE I (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:I
Last Name:DICKENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44994
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46244-0994
Mailing Address - Country:US
Mailing Address - Phone:317-274-4402
Mailing Address - Fax:317-278-1302
Practice Address - Street 1:1650 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1715
Practice Address - Country:US
Practice Address - Phone:317-880-0880
Practice Address - Fax:317-880-0860
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010483062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200230020Medicaid
INF42163Medicare UPIN
IN200230020Medicaid
IN116660VVVVMedicare ID - Type Unspecified