Rudolph, Liza Raquel

Rudolph, Liza Raquel is an individual health care provider with primary practice located at 255 E Sunset Ln , West Lafayette IN 47906-2456. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Rudolph, Liza Raquel can be contacted via phone (765) 532-9084.

Contact Information

Primary practice address
255 E Sunset Ln West Lafayette IN 47906-2456
Phone: (765) 532-9084
Fax: (765) 447-9659
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 200251030 Indiana

Profile Details

NPI number 1003863382
LBN Legal business name Rudolph, Liza Raquel
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date May 30th, 2006
Last updated May 5th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003863382 NPPES
Indiana Other 000000378693 BLUE CROSS/BLUE SHIELD
Indiana Other 251277 BLUE CROSS/BLUE SHIELD
Indiana MEDICAID 200251030B BLUE CROSS/BLUE SHIELD
Indiana Other 284435000 BLUE CROSS/BLUE SHIELD

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