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Contact Information

JERE W LEIB, PhD
3421 E STATE BLVD
FORT WAYNE, IN46805-4830
 Phone: 260-482-8427
 Fax: 260-482-8429
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for JERE W LEIB · (Male)

NPI # 1457350506
Status Active
Credentials PhD
Entity Individual
Enumeration date 07/20/2005
Last updated 08/12/2008 - About 18 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 20010181
  • IN Medicaid 100053650
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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