Jan Earl Warner, PHD HSPP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20040740A Issued in IN

Practice address

230 E Day Rd Ste 160
Mishawaka, IN 46545-3463

Phone

(574) 271-8222

Fax

(574) 271-8896

NPI assigned

Jun 10, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• Jan Earl Warner Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

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    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1043214679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 E DAY RD",
            "address_2": "#160",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453463",
            "telephone_number": "574-271-8222",
            "fax_number": "574-271-8896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 E DAY RD STE 160",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453463",
            "telephone_number": "574-271-8222",
            "fax_number": "574-271-8896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARNER",
        "first_name": "JAN",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "PHD HSPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IN",
            "license": "IN20040740",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IN",
            "license": "20040740A",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "IN",
            "license": "20040740A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20040740A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100383350A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000196536",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAN",
            "last_name": "WARNER",
            "middle_name": "EARL",
            "credential": "PHD, HSPP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Emma C Wang, DO
• Frank C Wang Jr., OD
• Jennifer Ward
• Charles McDonald Ware Jr., M.D.
• Jill N. Warfield-Ziegert, O.D.
• Shea Lee Warner
• Janelle Warrell
• Susan Marie Wassenhove, PA-C
• Kathye J Waters, LMHC
• Tosha E Watkins, MNT

• Clinical Psychologist in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.