Individual
MR. JERE W LEIB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
3421 E STATE BLVD, FORT WAYNE, IN 46805-4830
(260) 482-8427
(260) 482-8429
Mailing address
3421 E STATE BLVD, FORT WAYNE, IN 46805-4830
(260) 482-8427
(260) 482-8429
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20010181
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100053650
—
IN
Enumeration date
07/20/2005
Last updated
08/12/2008
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