Provider Demographics
NPI:1326873613
Name:WOOLEN, JAZMINE
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:
Last Name:WOOLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 FALL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4804
Mailing Address - Country:US
Mailing Address - Phone:317-813-4690
Mailing Address - Fax:
Practice Address - Street 1:6051 MADISON AVE APT 723
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5399
Practice Address - Country:US
Practice Address - Phone:317-675-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician