Individual
MRS. LIZA RAQUEL RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
255 E SUNSET LN, WEST LAFAYETTE, IN 47906-2456
(765) 532-9084
(765) 447-9659
Mailing address
PO BOX 3884, WEST LAFAYETTE, IN 47996-3884
(765) 532-9084
(765) 447-9659
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
200251030
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000378693
BLUE CROSS/BLUE SHIELD
IN
05
—
200251030B
—
IN
01
—
251277
VALUE OPTIONS
IN
01
—
284435000
MAGELLAN
IN
Enumeration date
05/30/2006
Last updated
05/05/2016
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