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Individual

DR. MICHAEL LEE SERETNY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHD, HSPP

Contact information

Practice address
1203 TRACE 12, WEST LAFAYETTE, IN 47906-1878
(765) 430-4049
Mailing address
1203 TRACE 12, WEST LAFAYETTE, IN 47906-1878
(765) 430-4049

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
20040537A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
20040537A
STATE LICENSE
IN
Enumeration date
07/22/2005
Last updated
02/21/2009
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