SOUGANDHI BACKHAUS PHD
Clinical Neuropsychologist
Indianapolis, Indiana
Provider NPI: 1780638619
Provider Information:SOUGANDHI BACKHAUS PHD
Gender: F
Not Sole Proprietor
Practice Location:
4141 SHORE DR INDIANAPOLIS, IN 46254 US
Tel: 317-329-2219 Fax: --
Business Mailing Address:
6804 WOOD HAVEN PL ZIONSVILLE, IN 46077 US
Tel: 317-879-8940 Fax: 317-872-0914
Entity Type: Individual
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 103G00000X | Behavioral Health & Social Service Providers Clinical Neuropsychologist | IN | 20041993 |
N | 103TC0700X | Behavioral Health & Social Service Providers Psychologist | IN | 20041993 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
200285860 | IN | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin