IndividualActive
Jacob Lutz, PHD
NPI 1164860052 · Clinical Neuropsychologist · Fort Wayne, IN
Provider details
- NPI number
- 1164860052
- Entity type
- Individual
- Primary specialty
- Clinical NeuropsychologistBehavioral Health & Social Service Providers
- Credential
- PHD
- Sex
- Male
- Sole proprietor
- No
- License
- 20042679A (IN)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Practice location
11104 Parkview Circle Dr Ste 110
Fort Wayne, IN 46845-1673
Phone: (260) 460-3203
Fax: (260) 460-3271
Approximate (ZIP-level) locationGet directions
Mailing address
11104 Parkview Circle Dr Ste 110
Fort Wayne, IN 46845-1673
Registry dates
- Enumerated
- 2013-06-13
- Last updated
- 2013-06-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.