SearchIndiana103TS0200X

Damo Antwine-Jelani, NCSP

NPI 1225792427 · on the registry since 2021 · sole proprietor

Practice

Address
2650 W 35th Ave
Gary, IN 46408
Phone
(630) 864-0704
Organisation at this address
Arc Bridges, Inc
The Arc Northwest Indiana
Global Leadership Academy, Inc.
Inferred from a shared address, not stated in the registry.

Registry record

Primary taxonomy
103TS0200X
103TS0200X
Also registered as
103TS0200X
Licence states on file
IN, IL
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2025-03-07

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana