MEDICARE: HEATHER R LAMPTON HSPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	20041895A	IN

General Provider Information

NPI Number	:	1376585653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER R LAMPTON HSPP

Provider Business Mailing Address
First Line	:	4650 OLD CLEVELAND RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-4324
Country	:	US
Telephone Number	:	574-232-8808
Fax Number	:	574-232-9270

Provider Business Practice Location Address
First Line	:	4650 OLD CLEVELAND RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-4324
Country	:	US
Telephone Number	:	574-232-8808
Fax Number	:	574-232-9270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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Directions to “ HEATHER R LAMPTON HSPP” Practice Location

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