Healthcare Provider Details

I. General information

NPI: 1811712888
Provider Name (Legal Business Name): KATELYN SCHAFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8707 W US HIGHWAY 36
MODOC IN
47358-9583
US

IV. Provider business mailing address

13252 EARLY SUNSET DR
MEMPHIS IN
47143-9669
US

V. Phone/Fax

Practice location:
  • Phone: 463-255-9677
  • Fax:
Mailing address:
  • Phone: 812-704-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10317087
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: