Organization
INTERDISCIPLINARY DIAGNOSTIC AND EVALUATION CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN NATHAN PH.D. (CLINICAL DIRECTOR)
(765) 284-9573
Entity
Organization
Contact information
Practice address
3030 LAKE AVE, SUITE 7, FORT WAYNE, IN 46805-5428
(260) 422-2838
Mailing address
3030 LAKE AVE, SUITE 7, FORT WAYNE, IN 46805-5428
(260) 422-2838
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
04/10/2007
Last updated
06/17/2008
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