Healthcare Provider Details

I. General information

NPI: 1902217441
Provider Name (Legal Business Name): MELISSA RUTEMOELLER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 N COUNTY ROAD 600 E
BROWNSBURG IN
46112-8107
US

IV. Provider business mailing address

3115 N COUNTY ROAD 600 E
BROWNSBURG IN
46112-8107
US

V. Phone/Fax

Practice location:
  • Phone: 317-662-4882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042749A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: