Healthcare Provider Details

I. General information

NPI: 1053435552
Provider Name (Legal Business Name): DIEDRA HAYMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 S MAIN ST
BLUFFTON IN
46714-3616
US

IV. Provider business mailing address

225 N. UNION ST.
BLUFFTON IN
46714
US

V. Phone/Fax

Practice location:
  • Phone: 260-824-1071
  • Fax:
Mailing address:
  • Phone: 260-215-5878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042116A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1826
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: