Individual
SUSAN M GERVERS-FEATHERGILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HSPP
Contact information
Practice address
2600 OAKLAND AVE, ELKHART, IN 46517-1533
(574) 533-1234
(574) 537-2652
Mailing address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042091A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000486394
ANTHEM PIN
IN
Enumeration date
07/10/2006
Last updated
01/28/2008
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