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General NPI Number Information
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NPI Number | 1881863686
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Entity Type | Organization
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Legal Business Name | SYDNEY F ANDERSON PHD LLC
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 637 N COLLEGE AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3871
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Country | US
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Telephone | 812-331-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 637 N COLLEGE AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3871
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Country | US
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Telephone | 812-331-2800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SYDNEY F ANDERSON
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Credential | PHD
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Telephone | 812-331-2800
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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 | 20040198A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20040198A
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License Number State | IN
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