MEDICARE: STAN T DUDLEY PH.D.

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	103TC0700X	Clinical Psychologist	3900	OH

General Provider Information

NPI Number	:	1861540429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STAN T DUDLEY PH.D.

Provider Business Mailing Address
First Line	:	1117 FEHL LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4349
Country	:	US
Telephone Number	:	513-231-8020
Fax Number	:	513-231-1222

Provider Business Practice Location Address
First Line	:	1117 FEHL LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-4349
Country	:	US
Telephone Number	:	513-231-8020
Fax Number	:	513-231-1222

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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Directions to “ STAN T DUDLEY PH.D.” Practice Location

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