Indiana Evaluation Services

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

License

20041846 Issued in IN

Legal business name

INDIANA EVALUATION SERVICES

Practice address

2633 E Dekist St
Bloomington, IN 47408-4216

Phone

(812) 333-1706

Fax

(812) 336-3283

NPI assigned

Apr 15, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dorothy Lynn O'Connor, LSW

Title

President

Phone

(812) 333-1706

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208217600000",
    "number": "1730353434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2633 DEKIST STREET",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474084216",
            "telephone_number": "812-333-1766",
            "fax_number": "812-336-8232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2633 E DEKIST ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474084216",
            "telephone_number": "812-333-1706",
            "fax_number": "812-336-3283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA EVALUATION SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-15",
        "last_updated": "2008-04-15",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-333-1706",
        "authorized_official_credential": "LSW"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "IN",
            "license": "20041846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual & Developmental Disabilities Psychologist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Intellectual & Developmental Disabilities Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.