Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 20042432A | IN |
NPI | 1013375823 |
---|---|
Provider Name | Dr. Shana Markle |
First Address | Logansport, IN 46947-1577 |
Second Address | Logansport, IN 46947-1577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2016 |
Last Update Date | 08/02/2016 |