Great Lakes Neuropsychology & Counseling Llc in Rockford - Clinical Neuropsychologist
Great Lakes Neuropsychology & Counseling Llc - NPI 1013030725
Great Lakes Neuropsychology & Counseling Llc is a Clinical Neuropsychologist in Rockford, Illinois. Great Lakes Neuropsychology & Counseling Llc practices all healthcare services and medical treatments related to Clinical Neuropsychologist. The NPI Number for Great Lakes Neuropsychology & Counseling Llc is 1013030725. The last update date is 2008-02-05.
Great Lakes Neuropsychology & Counseling Llc's current location address is 5758 Elaine Dr, Rockford, Illinois. You can contact this provider via phone number 8152311280 and fax number 8152311282. The mailing address for Great Lakes Neuropsychology & Counseling Llc is 5758 Elaine Dr, Rockford, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Great Lakes Neuropsychology & Counseling Llc |
|---|---|
| Address | 5758 Elaine Dr, Rockford, Illinois |
| Phone Number | 8152311280 |
| Fax Number | 8152311282 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | LICENSED C |
|---|---|
| Authorized Official Name | Bong A Shaun |
| Credentials | PSY.D. |
| Telephone Number | 8152311280 |
NPI Number Detail
| NPI Number | 1013030725 |
|---|---|
| Provider Enumeration Date | 2007-04-09 |
| Last Updated Date | 2008-02-05 |
Provider Mailing Address Detail
| Address | 5758 Elaine Dr |
|---|---|
| City | Rockford |
| State | Illinois (IL) |
| Post Code | 611083102 |
| Phone Number | 8152311280 |
| Fax Number | 8152311282 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical Neuropsychologist |
|---|---|
| Taxonomy | 103G00000X |
|
Definition: A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing th |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 215368 | IL | MEDICARE PTAN |
Post Comment/ Review Below
What is the Great Lakes Neuropsychology & Counseling Llc's 1013030725?
The Great Lakes Neuropsychology & Counseling Llc's NPI (National Provider Identifier) Number is 1013030725. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Can you provide the Great Lakes Neuropsychology & Counseling Llc's physical address?
The Great Lakes Neuropsychology & Counseling Llc is physically located at 5758 Elaine Dr, in the city of Rockford, IL, with the postal code 611083102.
What is Great Lakes Neuropsychology & Counseling Llc's primary area of medical expertise, and what taxonomy classification code corresponds to this specialized field?
The primary area of medical expertise for Great Lakes Neuropsychology & Counseling Llc is Clinical Neuropsychologist, and the corresponding taxonomy classification code for this specialized field is 103G00000X.
On what date did the Great Lakes Neuropsychology & Counseling Llc receive its 1013030725 assignment from the Centers for Medicare & Medicaid Services?
The Great Lakes Neuropsychology & Counseling Llc was assigned its 1013030725 by the Centers for Medicare & Medicaid Services on 2007-04-09.
When was the information regarding Great Lakes Neuropsychology & Counseling Llc, such as address, specialty, and other details, most recently verified or confirmed to be accurate?
The information pertaining to Great Lakes Neuropsychology & Counseling Llc, including its address, specialty, and other relevant details, was most recently verified or confirmed to be accurate on 2008-02-05.