Doctor Name: | DR. JAN E WARNER |
NPI Number: | 1043214679 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CP |
License Number: | IN20040740 |
Business Practice Address: | 230 E Day Rd #160 Mishawaka, IN - 465453463 |
Business Phone Number: | 5742718222 |
Business Fax Number: | 5742718896 |
Mailing Address: | 230 E Day Rd, #160 MISHAWAKA |
State: | IN |
Postal Code: | 465453463 |
Phone Number: | 5742718222 |
Fax Number: | 5742718896 |
NPI Enumeration Date: | 06/10/2005 |
NPI Last Update Date: | 08/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | IN20040740 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |