Active NPI
Jacqueline Brady
- Marriage & Family Therapist
- Mishawaka, IN
National Provider Identifier
1366097800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 35002567A
- Practice address
- 620 S Ironwood Dr Ste a
Mishawaka, IN 46544-1539 - Phone
- (800) 509-6884
- NPI assigned
- Aug 1, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 35002567A | IN | Primary |
Addresses
Primary practice location
620 S Ironwood Dr Ste a
Mishawaka, IN 46544-1539
Mailing address
620 S Ironwood Dr Ste a
Mishawaka, IN 46544-1539
Phone (219) 346-3633
Other names 1
- Jacqueline Ahearne
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35002567A | IN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780444800000",
"number": "1366097800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 S IRONWOOD DR STE A",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465441539",
"telephone_number": "219-346-3633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 S IRONWOOD DR STE A",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465441539",
"telephone_number": "800-509-6884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRADY",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-08-01",
"last_updated": "2026-06-03",
"certification_date": "2026-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "IN",
"license": "35002567A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACQUELINE",
"last_name": "AHEARNE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.