OrganizationActive
Interdisciplinary Diagnostic & Evaluation Center, Inc.
NPI 1134395510 · Intellectual & Developmental Disabilities Psychologist · Fort Wayne, IN
Provider details
- NPI number
- 1134395510
- Entity type
- Organization
- Primary specialty
- Intellectual & Developmental Disabilities PsychologistBehavioral Health & Social Service Providers
- Organization subpart
- No
- Authorized official
- Patsy Donn, President and Cfo(260) 422-2838
- License
- 20090014A (IN)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3030 Lake Ave Ste 7
Ft. Wayne
Fort Wayne, IN 46805-5428
Phone: (260) 422-2838
Street-level locationGet directions
Mailing address
3030 Lake Ave Ste 7
Fort Wayne, IN 46805-5428
Registry dates
- Enumerated
- 2008-05-05
- Last updated
- 2008-05-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.