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General NPI Number Information
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NPI Number | 1831180710
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Entity Type | Individual
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Provider Name | CAROL ERDMAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 615 N MICHIGAN ST
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City | SOUTH BEND
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State | IN
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Zip | 46601-1033
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Country | US
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Telephone | 574-647-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 710 N NILES AVE
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City | SOUTH BEND
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State | IN
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Zip | 46617-1924
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Country | US
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Telephone | 574-647-1610
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 20042017A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 071-006805
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6301013085
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 20142017A
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License Number State | IN
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