Christine M Liedtke, PSY.D., HSPP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20042492A Issued in IN

Practice address

14074 Trade Center Dr Ste 208
Fishers, IN 46038-4574

Phone

(440) 241-5275

NPI assigned

Nov 1, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Blossoming Minds Psychological Services, LLC

  • Psychologist
  • Fishers, IN
  • NPI 1649037730
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1288569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709510400000",
    "number": "1801196282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14074 TRADE CENTER DR STE 208",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460384574",
            "telephone_number": "440-241-5275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14074 TRADE CENTER DR STE 208",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460384574",
            "telephone_number": "440-241-5275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEDTKE",
        "first_name": "CHRISTINE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PSY.D., HSPP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-01",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20042492A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201092020",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brishen Marie Lewis-Weir
• Anne P Lewis, PHD, HSPP. LCAC
• Denisha Lewis
• Samantha Lewis
• Kathryn I Li, RPH
• Nicole Marie Liedtke, LCSW, LCAC
• Life Refined Chiropractic, LLC
• Lifestyle Mobility Plus, Inc.
• Lifetime Dental Care of Indiana, PC
• Rita S Liming, NP

• Psychologist in Fishers, IN
• Providers in Fishers, IN by specialty
• Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.