Provider Demographics
NPI:1851417554
Name:RUDIN, DALE I (PHD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:I
Last Name:RUDIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 MEDICAL PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3335
Mailing Address - Country:US
Mailing Address - Phone:512-328-7388
Mailing Address - Fax:512-329-6765
Practice Address - Street 1:4310 MEDICAL PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3335
Practice Address - Country:US
Practice Address - Phone:512-328-7388
Practice Address - Fax:512-329-6765
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L36AMedicare ID - Type Unspecified