Individual
MS. CATHY MARY JEROME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS ED
Contact information
Practice address
440 EDMOND DR, DYER, IN 46311-1523
(219) 322-1415
(219) 322-1414
Mailing address
440 EDMOND DR, DYER, IN 46311-1523
(219) 322-1415
(219) 322-1414
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
705380
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200673940
—
IN
05
—
200716000A
—
IN
Enumeration date
05/31/2006
Last updated
09/02/2008
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