| Doctor Name: | MRS. LIZA RAQUEL RUDOLPH |
| NPI Number: | 1003863382 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 200251030 |
| Business Practice Address: | 255 E Sunset Ln West Lafayette, IN - 479062456 |
| Business Phone Number: | 7655329084 |
| Business Fax Number: | 7654479659 |
| Mailing Address: | Po Box 3884, WEST LAFAYETTE |
| State: | IN |
| Postal Code: | 479963884 |
| Phone Number: | 7655329084 |
| Fax Number: | 7654479659 |
| NPI Enumeration Date: | 05/30/2006 |
| NPI Last Update Date: | 05/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 200251030 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |