Healthcare Provider Details

I. General information

NPI: 1730917964
Provider Name (Legal Business Name): ANGELA BONNIE PHILLIPS PSY.D., HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 SEBERGER DR
MUNSTER IN
46321-1628
US

IV. Provider business mailing address

632 QUAIL DR
HOBART IN
46342-2370
US

V. Phone/Fax

Practice location:
  • Phone: 219-588-7391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: