Individual
KATHLEEN MARIE ROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HSPP
Contact information
Practice address
2100 GOSHEN RD, FORT WAYNE, IN 46808-1493
(260) 471-3500
(260) 471-4263
Mailing address
850 N HARRISON ST, ATTN: ANNE LAWSON, WARSAW, IN 46580-3163
(574) 267-7169
(574) 268-2377
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041032A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100610A
—
IN
Enumeration date
10/04/2005
Last updated
11/19/2010
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