Active NPI
Teresa L Rudisill
- Clinical Psychologist
- Dayton, OH
National Provider Identifier
1114928181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4904
- Practice address
- 1020 Woodman Dr
Suite300
Dayton, OH 45432-1446 - Phone
- (937) 266-6914
- Fax
- (937) 426-1882
- NPI assigned
- Aug 2, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4904 | OH | Primary |
Addresses
Primary practice location
1020 Woodman Dr
Suite300
Dayton, OH 45432-1446
Mailing address
2817 Torrey Pnes
Beavercreek, OH 45431-8614
Phone (937) 266-6914
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4904 | OH | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Psychological Services Association | Clinical | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Dayton, OH
- NPI 1760483135
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359158400000",
"number": "1114928181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2817 TORREY PNES",
"city": "BEAVERCREEK",
"state": "OH",
"postal_code": "454318614",
"telephone_number": "937-266-6914",
"fax_number": "937-426-1882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 WOODMAN DR",
"address_2": "SUITE300",
"city": "DAYTON",
"state": "OH",
"postal_code": "454321446",
"telephone_number": "937-266-6914",
"fax_number": "937-426-1882"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDISILL",
"first_name": "TERESA",
"middle_name": "L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-08-02",
"last_updated": "2013-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "4904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.