Provider Demographics
NPI:1215330659
Name:REWERTS, JENNIFER RYAN (MS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RYAN
Last Name:REWERTS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RYAN
Other - Last Name:BRINKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2209 W US HIGHWAY 40
Mailing Address - Street 2:LOT # 12
Mailing Address - City:CLAYTON
Mailing Address - State:IN
Mailing Address - Zip Code:46118-8979
Mailing Address - Country:US
Mailing Address - Phone:317-997-4099
Mailing Address - Fax:
Practice Address - Street 1:3620 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4286
Practice Address - Country:US
Practice Address - Phone:765-620-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health