Healthcare Provider Details

I. General information

NPI: 1902139827
Provider Name (Legal Business Name): ASHLYN PYFER KNESEK PSYD HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RIDGE RD SUITE F
MUNSTER IN
46321-1726
US

IV. Provider business mailing address

900 RIDGE RD SUITE F
MUNSTER IN
46321-1726
US

V. Phone/Fax

Practice location:
  • Phone: 219-228-7630
  • Fax: 219-228-1083
Mailing address:
  • Phone: 219-228-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20042885A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: