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General NPI Number Information
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NPI Number | 1811331671
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Entity Type | Individual
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Provider Name | SUZANNE LEIPHART PHD
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Gender | Female
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 8419 SHOREWAY DR 1111 E. 54TH STREET SUITE 104
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-2436
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Country | US
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Telephone | 317-920-8029
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Fax | 317-377-4276
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Provider Business Mailing Address
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Address Line | 8419 SHOREWAY DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-2436
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Country | US
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Telephone | 317-920-8029
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Fax | 317-377-4276
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20040049A
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License Number State | IN
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