Individual
JENNIE CONRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC, NCC
Contact information
Practice address
3563 S STATE ROAD 13, WABASH, IN 46992-9162
(260) 563-8452
(260) 569-0335
Mailing address
3563 S STATE ROAD 13, WABASH, IN 46992-9162
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39001595A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000502787
ANTHEM PIN NUMBER
IN
Enumeration date
05/18/2007
Last updated
07/08/2007
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