Individual
SOUGANDHI BACKHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4141 SHORE DR, INDIANAPOLIS, IN 46254-2607
(317) 329-2219
Mailing address
6804 WOOD HAVEN PL, ZIONSVILLE, IN 46077-8560
(317) 879-8940
(317) 872-0914
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
20041993
IN
103TC0700X
Clinical Psychologist
20041993
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200285860
—
IN
Enumeration date
05/22/2006
Last updated
07/01/2011
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