Individual
JERRY JERRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1305 CUMBERLAND AVE, WEST LAFAYETTE, IN 47906-1310
(812) 483-5533
(812) 483-5533
Mailing address
1305 CUMBERLAND AVE STE 225, WEST LAFAYETTE, IN 47906-1343
(812) 483-5533
(812) 483-5533
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
IN
Other
Enumeration date
09/10/2024
Last updated
09/10/2024
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