Healthcare Provider Details

I. General information

NPI: 1144555855
Provider Name (Legal Business Name): PAULA A. NEUMAN ED.D., PSY.D., HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BROADWAY STE 350
FORT WAYNE IN
46802-1412
US

IV. Provider business mailing address

750 BROADWAY STE 350
FORT WAYNE IN
46802-1412
US

V. Phone/Fax

Practice location:
  • Phone: 260-423-2675
  • Fax: 260-423-6621
Mailing address:
  • Phone: 260-423-2675
  • Fax: 260-423-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number20042473A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: