Individual
STEPHANIE ANNE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D., HSPP
Contact information
Practice address
601 WALL ST, VALPARAISO, IN 46383-2512
(219) 476-4577
Mailing address
5202 BROOKLINE DR, PORTAGE, IN 46368-5160
(219) 688-3514
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042508A
IN
Other
Enumeration date
11/24/2009
Last updated
02/28/2012
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