Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 20041104A | IN |
Y | 103T00000X | Psychologist | 20041104A | IN |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 20041104A | IN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 20041104A | IN |
NPI | 1487678728 |
---|---|
Provider Name | Dr. Linda J Hanner |
First Address | Rockville, IN 47872-1536 |
Second Address | Rockville, IN 47872-1536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 05/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000356184 | ANTHEM (01) | IN |
200119440B | (05) | IN |
224190A | MEDICARE PTAN (01) | IN |
753163279 | SAGAMORE (01) | IN |
801182000 | MAGELLAN (01) | IN |