| Generational Bridges Neuropsychological Services Pllc | |
|
1515 E Missouri Ave Ste 110 Phoenix AZ 85014-2443 | |
| (623) 322-9936 | |
| (623) 218-1337 |
| Full Name | Generational Bridges Neuropsychological Services Pllc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 1515 E Missouri Ave Ste 110, Phoenix, Arizona |
| Authorized Official Name and Position | Stephanie Middaugh (PRESIDENT) |
| Authorized Official Contact | 6233229936 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Generational Bridges Neuropsychological Services Pllc 1515 E Missouri Ave Ste 110 Phoenix AZ 85014-2443 Ph: (623) 322-9936 | Generational Bridges Neuropsychological Services Pllc 1515 E Missouri Ave Ste 110 Phoenix AZ 85014-2443 Ph: (623) 322-9936 |
| NPI Number | 1467088062 |
|---|---|
| Provider Enumeration Date | 03/16/2020 |
| Last Update Date | 03/15/2021 |
| Certification Date | 03/15/2021 |
| Medicare PECOS PAC ID | 8426479627 |
|---|---|
| Medicare Enrollment ID | O20200526001047 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467088062 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Stephanie R Middaugh |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699338863 PECOS PAC ID: 3779826169 Enrollment ID: I20190529000856 |
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