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Individual

KATHERINE A BOLSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
HSPP

Contact information

Practice address
415 N 26TH ST, LAFAYETTE, IN 47904-2895
(765) 446-6535
(765) 446-3536
Mailing address
415 N 26TH ST, LAFAYETTE, IN 47904-2895
(765) 446-6535
(765) 446-3536

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
PENDING
IN
103TH0100X
Health Service Psychologist
Primary
20043271A
IN
103TH0100X
Health Service Psychologist
PENDING
IN

Other

Enumeration date
08/27/2018
Last updated
07/03/2019
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