Provider Demographics
NPI:1790800910
Name:ROHRER, WENDELL ALAN (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:ALAN
Last Name:ROHRER
Suffix:
Gender:M
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4667
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46634-4667
Mailing Address - Country:US
Mailing Address - Phone:574-523-3148
Mailing Address - Fax:574-523-3492
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-523-3242
Practice Address - Fax:574-523-7917
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040843103G00000X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20040843OtherSTATE LICENSE