Organization
INTERDISCIPLINARY DIAGNOSTIC & EVALUATION CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATSY A. DONN ED.D. (PRESIDENT AND CFO)
(260) 422-2838
Entity
Organization
Contact information
Practice address
3030 LAKE AVE STE 7, FT. WAYNE, FORT WAYNE, IN 46805-5428
(260) 422-2838
Mailing address
3030 LAKE AVE STE 7, FT. WAYNE, FORT WAYNE, IN 46805-5428
(260) 422-2838
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
20090014A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100080770 A
—
IN
Enumeration date
05/05/2008
Last updated
05/05/2008
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