Individual
KELLY RENEE DARDEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1241 CUMBERLAND AVE, WEST LAFAYETTE, IN 47906-1304
(812) 629-4999
(765) 607-1483
Mailing address
1241 CUMBERLAND AVE, WEST LAFAYETTE, IN 47906-1304
(812) 629-4999
(765) 607-1483
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20042319A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001056306
ANTHEM PROVIDER NUMBER
IN
Enumeration date
10/23/2008
Last updated
12/01/2023
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