Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 20041675A | IN |
Y | 103T00000X | Psychologist | 20041675A | IN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 20041675 | IN |
NPI | 1083661391 |
---|---|
Provider Name | Ann M Lagges |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-1239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2006 |
Last Update Date | 01/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200352170 | (05) | IN |
P59116 | (02) | IN |