MR. JERE W LEIB (NPI# 1457350506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457350506 |
| Entity Type | Individual |
| Full Name | MR. JERE W LEIB |
| Credential | PH.D. |
| Practice Address |
3421 E State Blvd Fort Wayne IN 46805-4830 |
| Practice Telephone | 2604828427 |
| Practice Fax Number | 2604828429 |
| Mailing Telephone | 2604828427 |
| Mailing Fax Number | 2604828429 |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2008-08-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
20010181 | IN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100053650 | 05 |
| Street Address |
3421 E STATE BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-4830 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992912471 | Nancy Scrogham Gerow | Marriage & Family Therapist | 3421 E State Blvd, Fort Wayne, IN 46805-4830 | 2007-05-16 |
| 1558441063 | Psychological Service Associates, Inc | Psychologist | 3421 E State Blvd, Fort Wayne, IN 46805-4830 | 2006-10-17 |
| 1932108982 | Rodney E Timbrook | Psychologist | 3421 E State Blvd, Fort Wayne, IN 46805-4830 | 2005-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164052791 | Kadlec Consulting Services, LLC | Psychologist | 5525 Oak Valley Pl, Fort Wayne, IN 46845-1836 | 2020-01-23 |
| 1053628248 | Kelly Stewart Hutner | Psychologist | 11143 Parkview Plaza Dr Ste 320, Fort Wayne, IN 46845-1728 | 2010-09-09 |
| 1730495813 | Spencer Jenkins Booth | Psychologist | 6526 W Jefferson Blvd, Fort Wayne, IN 46804-6206 | 2010-08-26 |
| 1750519377 | Thomas Paul Dettmer | Psychologist | 6223 Constitution Dr, Fort Wayne, IN 46804-1517 | 2009-06-23 |
| 1750509667 | Casey Nelson | Psychologist | 1515 Magnavox Way, Fort Wayne, IN 46804-1533 | 2007-04-23 |
| 1982732491 | Shirley F Shiff | Psychologist | 8424 Victoria Woods Pl, Fort Wayne, IN 46825-6510 | 2007-02-28 |
| 1912080359 | Abigail Dormire Powers | Psychologist | 10311 Dawsons Creek Blvd, Suite F, Fort Wayne, IN 46825-1913 | 2006-10-21 |
| 1376593046 | Wayne James Von Bargen | Psychologist | 1910 Saint Joe Center Rd, Suite 44, Fort Wayne, IN 46825-5000 | 2006-05-11 |
| 1093774796 | Mcgee-lytle Inc | Psychologist | 2020 E Washington Blvd, Suite 650, Fort Wayne, IN 46803-1327 | 2006-03-21 |
| 1043283641 | Jason T. Cook | Psychologist | 7230 Engle Rd, Ste 304, Fort Wayne, IN 46804-2209 | 2006-02-13 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
Please comment or provide details below to improve the information on MR. JERE W LEIB.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.