Individual
JENNIFER A. FRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D., HSPP
Contact information
Practice address
1700 E 38TH ST, MARION, IN 46953-4568
(765) 674-3321
Mailing address
5123 FOREST GROVE DR, FORT WAYNE, IN 46835-3709
(260) 485-6971
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041632A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200371000
—
IN
Enumeration date
10/25/2005
Last updated
03/20/2013
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