Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PENDING | IN |
N | 103T00000X | Psychologist | PENDING | IN |
Y | 103TH0100X | Health Service | 20043271A | IN |
N | 103TH0100X | Health Service | PENDING | IN |
NPI | 1326529306 |
---|---|
Provider Name | Katherine A Bolsen |
First Address | Lafayette, IN 47904-2895 |
Second Address | Lafayette, IN 47904-2895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 03/07/2019 |