Healthcare Provider Details

I. General information

NPI: 1447265152
Provider Name (Legal Business Name): BARBARA C GELDER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/03/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 E STATE BLVD STE 600
FORT WAYNE IN
46805-4762
US

IV. Provider business mailing address

3010 E STATE BLVD STE 600
FORT WAYNE IN
46805-4762
US

V. Phone/Fax

Practice location:
  • Phone: 260-471-2300
  • Fax: 260-471-2778
Mailing address:
  • Phone: 260-471-2300
  • Fax: 260-471-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2004179A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: