Healthcare Provider Details

I. General information

NPI: 1518091768
Provider Name (Legal Business Name): STEVEN ROGER RUMBLE PH.D. HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E SOUTHPORT RD SUITE C
INDIANAPOLIS IN
46227-8592
US

IV. Provider business mailing address

704 COVERED BRIDGE RD
GREENWOOD IN
46142-1112
US

V. Phone/Fax

Practice location:
  • Phone: 317-782-6015
  • Fax: 317-782-6929
Mailing address:
  • Phone: 317-887-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20040148
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: