Active NPI
Carol Ann Tageson, PSY.D
- Clinical Psychologist
- South Bend, IN
National Provider Identifier
1639208481
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20041646A
- Practice address
- 828 E Colfax Ave
South Bend, IN 46617-2804 - Phone
- (574) 233-3003
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- No
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 | 20041646A | IN | Primary |
Addresses
Primary practice location
828 E Colfax Ave
South Bend, IN 46617-2804
Mailing address
828 E Colfax Ave
South Bend, IN 46617-2804
Phone (574) 233-3003
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20041646A | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184544000000",
"number": "1639208481",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "828 E COLFAX AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466172804",
"telephone_number": "574-233-3003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "828 E COLFAX AVE",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466172804",
"telephone_number": "574-233-3003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAGESON",
"first_name": "CAROL",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "PSY.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2007-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20041646A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.