Provider Demographics
NPI:1770911687
Name:NORRIS, JENNIFER L (LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:NORRIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:INDIANAPOLIS
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-278-9922
Mailing Address - Fax:317-278-9925
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 3038C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-274-2617
Practice Address - Fax:317-274-2587
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN330067911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical