Individual
DR. SUSAN ANN DWYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD CLINICAL PSYCHOL
Contact information
Practice address
203W WAYNE ST 317, FORT WAYNE, IN 46802-3610
(260) 413-0040
(260) 344-2820
Mailing address
1702 GLEN ELM DR, FORT WAYNE, IN 46845-9672
(260) 413-0040
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
Primary
20041233
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200142310
—
IN
Enumeration date
07/20/2005
Last updated
11/09/2015
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