Healthcare Provider Details

I. General information

NPI: 1710051768
Provider Name (Legal Business Name): ANNE BOCH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N WALNUT ST STE 203 SUITE 203
BLOOMINGTON IN
47404-4926
US

IV. Provider business mailing address

PO BOX 5124
BLOOMINGTON IN
47407-5124
US

V. Phone/Fax

Practice location:
  • Phone: 812-320-0544
  • Fax:
Mailing address:
  • Phone: 812-320-0544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20041250
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: