Individual
PAUL J. YODER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HSPP
Contact information
Practice address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
Mailing address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040072A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000202228
ANTHEM PIN
—
05
—
200014860
—
IN
Enumeration date
06/05/2006
Last updated
05/08/2009
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