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General NPI Number Information
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NPI Number | 1326322439
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Entity Type | Organization
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Legal Business Name | RUDISILL PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 01/26/2013
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Provider Practice Location Address
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Address Line | 1020 WOODMAN DR STE 300
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City | DAYTON
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State | OH
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Zip | 45432-1446
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Country | US
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Telephone | 937-266-6914
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Fax | 937-434-8590
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Provider Business Mailing Address
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Address Line | 1020 WOODMAN DR STE 300
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City | DAYTON
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State | OH
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Zip | 45432-1446
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Country | US
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Telephone | 937-266-6914
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Fax | 937-426-1882
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | TERESA RUDISILL
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Credential |
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Telephone | 937-266-6914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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