Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 20040820 | IN |
NPI | 1215698121 |
---|---|
Provider Name | Dr. Susan G Ball |
First Address | Indianapolis, IN 46278-1652 |
Second Address | Indianapolis, IN 46268-3190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2022 |
Last Update Date | 03/01/2022 |