Provider Demographics
NPI:1912590381
Name:VERDON, HEATHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:VERDON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 WRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-6030
Mailing Address - Country:US
Mailing Address - Phone:317-469-6847
Mailing Address - Fax:
Practice Address - Street 1:1 PARK ROW ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6597
Practice Address - Country:US
Practice Address - Phone:219-874-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043090A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical