Individual
KELLY S EARNST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D, HSPP
Contact information
Practice address
1415 SALEM ST, SUITE 102, LAFAYETTE, IN 47904-4100
(765) 742-1816
(765) 742-2557
Mailing address
202 MYERS RD, DANVILLE, IN 46122-9702
(317) 718-8436
(317) 718-8438
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
20041614A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200283610A
—
IN
Enumeration date
10/24/2006
Last updated
06/27/2022
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