Organization · NPI-2

Fort Wayne Neuropsychology LLC

Clinical Neuropsychologist · Fort Wayne, IN

NPI number1871032862
StatusActive
Last updated in NPPESFeb 23, 2017

Details

NPI
1871032862
Entity type
Organization (NPI-2)
Legal business name
Fort Wayne Neuropsychology LLC
Organization subpart
No
Enumeration date
Feb 23, 2017
Last updated
Feb 23, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
103G00000X Clinical Neuropsychologist––Yes
103T00000X Psychologist––
1041C0700X Social Worker, Clinical––

Practice location

4306 E State Blvd
Fort Wayne, IN 46815-6915

Phone 260-460-3100

Mailing address

4306 E State Blvd
Fort Wayne, IN 46815-6915

Authorized official

Tasha H. Williams
Vice President
2604148629

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