Provider Demographics
NPI:1487700639
Name:HESS, JACQUELINE LEWIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LEWIS
Last Name:HESS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9240 N MERIDIAN ST
Mailing Address - Street 2:STE 320
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1822
Mailing Address - Country:US
Mailing Address - Phone:317-574-1785
Mailing Address - Fax:317-574-1786
Practice Address - Street 1:201 W 103RD ST
Practice Address - Street 2:SUITE 280
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1087
Practice Address - Country:US
Practice Address - Phone:317-574-1785
Practice Address - Fax:317-574-1786
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN20040850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical