Individual
TARA TODD LINEWEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
9531 VALPARAISO CT, INDIANAPOLIS, IN 46268-1130
(317) 879-8940
(317) 872-0914
Mailing address
1854 RELIABLE PKWY, CHICAGO, IL 60686-0001
(270) 744-9600
(270) 744-0834
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041964A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200944120
—
IN
Enumeration date
06/05/2009
Last updated
06/06/2011
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