| Fort Wayne Neuropsychology Llc | |
|
4306 E State Blvd Fort Wayne IN 46815-6915 | |
| (260) 460-3100 | |
| Not Available |
| Full Name | Fort Wayne Neuropsychology Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 4306 E State Blvd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Tasha H. Williams (VICE PRESIDENT) |
| Authorized Official Contact | 2604148629 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fort Wayne Neuropsychology Llc 4306 E State Blvd Fort Wayne IN 46815-6915 Ph: () - | Fort Wayne Neuropsychology Llc 4306 E State Blvd Fort Wayne IN 46815-6915 Ph: (260) 460-3100 |
| NPI Number | 1871032862 |
|---|---|
| Provider Enumeration Date | 02/23/2017 |
| Last Update Date | 02/23/2017 |
| Medicare PECOS PAC ID | 0345526893 |
|---|---|
| Medicare Enrollment ID | O20170417001683 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871032862 | NPI | - | NPPES |
| Provider Name | Tasha H Williams |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467499780 PECOS PAC ID: 9931106093 Enrollment ID: I20061102000263 |
| Provider Name | Margaret L Jones |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396850236 PECOS PAC ID: 5496756595 Enrollment ID: I20070116000183 |
| Provider Name | Peter Dodzik |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1437156999 PECOS PAC ID: 8224110275 Enrollment ID: I20080129000646 |
| Provider Name | Jacob T Lutz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164860052 PECOS PAC ID: 6901040138 Enrollment ID: I20130910000253 |
| Provider Name | Erin M Miles |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699196519 PECOS PAC ID: 0446480784 Enrollment ID: I20140305001572 |
| Provider Name | Kelly L Hoover |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1447891312 PECOS PAC ID: 0042541344 Enrollment ID: I20191018000065 |
| Provider Name | Lori Stock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255974804 PECOS PAC ID: 3870925431 Enrollment ID: I20191120000610 |
| Provider Name | Cynthia L Shepherd |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1689899486 PECOS PAC ID: 7416385885 Enrollment ID: I20200318000447 |
| Provider Name | Catherine M Short |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912686627 PECOS PAC ID: 9537521752 Enrollment ID: I20230818001972 |
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