Individual
DR. JAN EARL WARNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD HSPP
Contact information
Practice address
230 E DAY RD STE 160, MISHAWAKA, IN 46545-3463
(574) 271-8222
(574) 271-8896
Mailing address
230 E DAY RD, #160, MISHAWAKA, IN 46545-3463
(574) 271-8222
(574) 271-8896
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
20040740A
IN
103G00000X
Clinical Neuropsychologist
IN20040740
IN
103TB0200X
Cognitive & Behavioral Psychologist
20040740A
IN
103TC0700X
Clinical Psychologist
Primary
20040740A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000196536
BLUE CROSS BLUE SHIELD
IN
05
—
100383350A
—
IN
Enumeration date
06/10/2005
Last updated
09/03/2021
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