Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 20042116A | IN |
Y | 103TC0700X | Clinical Psychologist | 20042116A | IN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1826 | AL |
NPI | 1053435552 |
---|---|
Provider Name | Diedra Hayman |
First Address | Bluffton, IN 46714 |
Second Address | Bluffton, IN 46714-3616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 21/02/2017 |