Individual
GAYLE Y IWAMASA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., HSPP
Contact information
Practice address
1415 SALEM ST, SUITE 102, LAFAYETTE, IN 47904-4100
(765) 742-1816
(765) 742-2557
Mailing address
6991 E 375 S, LAFAYETTE, IN 47905-9461
(765) 742-1826
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040904A
IN
Other
Enumeration date
10/06/2006
Last updated
07/08/2007
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