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General NPI Number Information
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NPI Number | 1285455436
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Entity Type | Individual
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Provider Name | AMANDA J TALLEY
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 3326 COUNTY ROAD 427
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City | WATERLOO
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State | IN
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Zip | 46793-9532
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Country | US
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Telephone | 260-920-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 1607 DOWLING ST
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City | KENDALLVILLE
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State | IN
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Zip | 46755-9407
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Country | US
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Telephone | 260-347-5236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 10233605
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License Number State | IN
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