Individual
HEIDI L MUSGRAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
2250 LAKE AVE STE 110, FORT WAYNE, IN 46805-5352
(260) 409-2099
(260) 436-2135
Mailing address
2250 LAKE AVE STE 110, FORT WAYNE, IN 46805-5352
(260) 409-2099
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041626A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200303330
—
IN
Enumeration date
08/17/2005
Last updated
01/17/2023
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