Provider Demographics
NPI:1730353434
Name:INDIANA EVALUATION SERVICES
Entity type:Organization
Organization Name:INDIANA EVALUATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:812-333-1706
Mailing Address - Street 1:2633 DEKIST STREET
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-4216
Mailing Address - Country:US
Mailing Address - Phone:812-333-1766
Mailing Address - Fax:812-336-8232
Practice Address - Street 1:2633 E DEKIST ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-4216
Practice Address - Country:US
Practice Address - Phone:812-333-1706
Practice Address - Fax:812-336-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041846103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty