INTERDISCIPLINARY DIAGNOSTIC & EVALUATION CENTER, INC. (NPI# 1134395510) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134395510 |
| Entity Type | Organization |
| Organization Name | INTERDISCIPLINARY DIAGNOSTIC & EVALUATION CENTER, INC. |
| Practice Address |
3030 Lake Ave Ste 7 Ft. Wayne Fort Wayne IN 46805-5428 |
| Practice Telephone | 2604222838 |
| Mailing Telephone | 2604222838 |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2008-05-05 |
| Authorized Official Name | DR. PATSY A. DONN (PRESIDENT AND CFO) |
| Authorized Official Telephone | 2604222838 |
| Authorized Official Credential | ED.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TM1800X |
Psychologist Specialization: Mental Retardation & Developmental Disabilities |
20090014A | IN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100080770 A | 05 |
| Street Address |
3030 LAKE AVE STE 7 FT. WAYNE |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-5428 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770759169 | Patsy A. Donn | Psychologist | 3030 Lake Ave Ste 7, Fort Wayne, IN 46805-5428 | 2008-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| Taxonomy Code | 103TM1800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Mental Retardation & Developmental Disabilities |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407489321 | Angela Sands | Psychologist | 8148 Devon Ave, Indianapolis, IN 46239-1595 | 2020-02-19 |
| 1326212010 | Glenn Michael Merepith | Psychologist | 421 E Allen St, Bloomington, IN 47401 | 2008-04-15 |
| 1730353434 | Indiana Evaluation Services | Psychologist | 2633 E Dekist St, Bloomington, IN 47408-4216 | 2008-04-15 |
| 1912177510 | Brenda Stiers Carter | Psychologist | 750 Delray Dr, Indianapolis, IN 46241-1785 | 2008-03-11 |
| 1730357179 | Elise Lillard Ipock | Psychologist | 414 Harrison St, West Lafayette, IN 47906-3516 | 2008-02-19 |
| 1336262815 | Julie Renee Morton | Psychologist | 4701 N Robbs Ln, Bloomington, IN 47408-9454 | 2007-04-09 |
| 1902927700 | Marta Kay Knauer | Psychologist | 2416 N D St, Elwood, IN 46036-1647 | 2007-04-02 |
| 1780746800 | Susanne Jo Bauer | Psychologist | 5155 Little Flock Rd, Spencer, IN 47460-5878 | 2006-12-14 |
| 1407932791 | Richard Paul Lookatch | Psychologist | 700 S Grant St, Bloomington, IN 47401-4733 | 2006-10-29 |
| 1487741633 | Soper Consulting, PC | Psychologist | 12999 Parkside Drive, Fishers, IN 46038 | 2006-10-09 |
| Find all providers with the same taxonomy | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
Please comment or provide details below to improve the information on INTERDISCIPLINARY DIAGNOSTIC & EVALUATION CENTER, INC..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.