Healthcare Provider Details

I. General information

NPI: 1467650754
Provider Name (Legal Business Name): CADWELL PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N MICHIGAN ST SUITE 204
PLYMOUTH IN
46563-1770
US

IV. Provider business mailing address

310 N MICHIGAN ST SUITE 204
PLYMOUTH IN
46563-1770
US

V. Phone/Fax

Practice location:
  • Phone: 574-936-3031
  • Fax:
Mailing address:
  • Phone: 574-936-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042025A
License Number StateIN

VIII. Authorized Official

Name: CARRIE ANN CADWELL
Title or Position: PSYCHOLOGIST LLC MEMBER
Credential: PSY.D.
Phone: 574-936-3031