Individual
MARY M KADLEC
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PSYD HSPP
Contact information
Practice address
4214 HOBSON CT, FORT WAYNE, IN 46815-8648
(260) 486-5251
(260) 486-5058
Mailing address
4214 HOBSON CT, FORT WAYNE, IN 46815-8648
(260) 486-5251
(260) 486-5058
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20040944A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000296403
ANTHEM
—
01
—
0007607161
AETNA US HEALTHCARE
—
05
—
20027420A
—
IN
01
—
256981
VALUE OPTIONS
—
01
—
36768
CIGNA
—
Enumeration date
09/14/2005
Last updated
07/08/2007
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