MEDICARE: DR. MARLA J SOUDER PSY.D., HSPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	20042225A	IN
2	103TC0700X	Clinical Psychologist	20042225A	IN

General Provider Information

NPI Number	:	1548420474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARLA J SOUDER PSY.D., HSPP

Provider Business Mailing Address
First Line	:	2599 COUNTY ROAD 72
Second Line	:
City	:	AUBURN
State	:	IN
Zip	:	46706-2271
Country	:	US
Telephone Number	:	260-615-9971
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 S LANDMARK AVE
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47403-5000
Country	:	US
Telephone Number	:	812-269-3214
Fax Number	:	317-520-8200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	01/31/2025

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