Jennifer Ellis, Ed.S., NCSP
Psychologist, School in Fort Wayne, IN. Individual provider (NPI-1).
NPI number1790502425
StatusActive
Last updated in NPPESSep 24, 2024
Details
- NPI
- 1790502425
- Entity type
- Individual (NPI-1)
- Name
- Jennifer Ellis
- Credential
- Ed.S., NCSP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 24, 2024
- Certification date
- Sep 24, 2024
- Last updated
- Sep 24, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TS0200X | Psychologist, School | 10072965 | IN | Yes |
Practice location
1515 S Scott RdFort Wayne, IN 46814-9399
Phone 260-431-0728
Mailing address
1515 S Scott RdFort Wayne, IN 46814-9399
Phone 260-431-0728
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 30 School Psychologist providers in Fort Wayne · All 11,302 providers in Fort Wayne
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