Individual
MS. JEANNE HARBER PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, ACSW
Contact information
Practice address
4109 W JEFFERSON BLVD, STE A, FORT WAYNE, IN 46804-6894
(260) 486-5251
(260) 486-5058
Mailing address
4109 W JEFFERSON BLVD, STE A, FORT WAYNE, IN 46804-6894
(260) 486-5251
(260) 486-5058
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
34004475A
IN
1041C0700X
Clinical Social Worker
Primary
34004475A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000174858
ANTHEM
—
01
—
0007385540
AETNA US HEALTHCARE
—
05
—
200522940A
—
IN
01
—
2204791
CIGNA
—
01
—
58639900
MAGELLAN BEHAVIORAL HEALT
—
Enumeration date
09/13/2005
Last updated
04/03/2024
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