Individual
MICHELE KOSELKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD, HSPP
Contact information
Practice address
205 N COLLEGE AVE STE 312, BLOOMINGTON, IN 47404-3953
(317) 941-3258
(317) 534-3677
Mailing address
1781 SPRING BEAUTY DR, AVON, IN 46123-8441
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20042414A
IN
103TC0700X
Clinical Psychologist
20042414A
IN
Other
Enumeration date
04/08/2010
Last updated
09/09/2020
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