Healthcare Provider Details

I. General information

NPI: 1255327748
Provider Name (Legal Business Name): GWEN C SPREHN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT OF NEUROLOGY INDIANA UNIVERSITY SCHOOL OF MED 541 CLINICAL DRIVE (CL-299)
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 130 - PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-7327
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number20042146A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: