Individual
JEROME ELMER MODLIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8102 CLEARVISTA PKWY, INDIANAPOLIS, IN 46256-1661
(317) 849-8222
Mailing address
8055 N RICHARDT AVE, INDIANAPOLIS, IN 46256-1619
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20040316A
IN
103TA0400X
Addiction (Substance Use Disorder) Psychologist
20040316A
IN
Other
Enumeration date
07/16/2008
Last updated
07/16/2008
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