Provider Demographics
NPI:1659443240
Name:OSMUNSON, STANLEY E (EDD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:E
Last Name:OSMUNSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 SHORE DR STE 303
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4693
Mailing Address - Country:US
Mailing Address - Phone:317-328-1200
Mailing Address - Fax:317-328-1200
Practice Address - Street 1:3850 SHORE DR STE 303
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4693
Practice Address - Country:US
Practice Address - Phone:317-328-1200
Practice Address - Fax:317-328-1200
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040222A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000184223OtherANTHEM BLUE CROSS BLUE SH
IN000000184223OtherANTHEM BLUE CROSS BLUE SH