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General NPI Number Information
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NPI Number | 1528889474
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Entity Type | Individual
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Provider Name | KAREN NASSTROM
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Gender | Female
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 7600 W REEVES RD
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City | BLOOMINGTON
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State | IN
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Zip | 47404-9639
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Country | US
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Telephone | 812-325-3517
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Fax |
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Provider Business Mailing Address
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Address Line | 1488 W ADAMS HILL CIR
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City | BLOOMINGTON
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State | IN
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Zip | 47403-3241
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Country | US
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Telephone | 812-325-3517
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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 | 1373574
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License Number State | IN
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