MEDICARE: GAIL KIBIGER PSYD, 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	20041878	IN

General Provider Information

NPI Number	:	1770531477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL KIBIGER PSYD, HSPP

Provider Business Mailing Address
First Line	:	PO BOX 4323
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47804-0323
Country	:	US
Telephone Number	:	812-231-8323
Fax Number	:	812-231-8400

Provider Business Practice Location Address
First Line	:	602 N HIGH SCHOOL RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-3694
Country	:	US
Telephone Number	:	317-484-5380
Fax Number	:	317-243-2326

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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