Individual
KASSANDRA A. R. SHELLABARGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1002 WISHARD BLVD, INDIANAPOLIS, IN 46202-2872
(317) 274-4779
(317) 948-9806
Mailing address
PO BOX 719094, CHICAGO, IL 60677-9318
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
20044050B
IN
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
6351004735
MI
103TC0700X
Clinical Psychologist
Primary
20044050A
IN
103TC0700X
Clinical Psychologist
Primary
20044050B
IN
103TC0700X
Clinical Psychologist
6301019759
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300124477
—
IN
Enumeration date
09/24/2024
Last updated
04/17/2026
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