Individual
LAUREL B BRUNDAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
7300 E INDIANA ST STE 103, EVANSVILLE, IN 47715-2794
(812) 401-8008
(812) 401-8201
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
00435
IA
103T00000X
Psychologist
00948
IA
103T00000X
Psychologist
Primary
20042407A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0439240
—
IA
01
—
34115
WELLMARK HEALTH PLAN
IA
01
—
IA01K6
JOHN DEERE HEALTH PLAN
—
Enumeration date
10/06/2005
Last updated
10/05/2015
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