| Meridian Neuropsychology Pllc | |
|
3061 S Meridian Rd Ste 100 Meridian ID 83642-7962 | |
| (208) 895-9852 | |
| (208) 629-1231 |
| Full Name | Meridian Neuropsychology Pllc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 3061 S Meridian Rd, Meridian, Idaho |
| Authorized Official Name and Position | Jason Southwick (MANAGER) |
| Authorized Official Contact | 2088959852 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meridian Neuropsychology Pllc 3597 E Monarch Sky Ln Ste 240 Meridian ID 83646-1055 Ph: (208) 391-7274 | Meridian Neuropsychology Pllc 3061 S Meridian Rd Ste 100 Meridian ID 83642-7962 Ph: (208) 895-9852 |
| NPI Number | 1114321163 |
|---|---|
| Provider Enumeration Date | 10/20/2014 |
| Last Update Date | 05/18/2024 |
| Certification Date | 05/18/2024 |
| Medicare PECOS PAC ID | 6002139292 |
|---|---|
| Medicare Enrollment ID | O20141218002135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114321163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | PSY-202728 (Idaho) | Primary |
| 103TC0700X | Psychologist - Clinical | PSY-202728 (Idaho) | Secondary |
| Provider Name | Jason S Southwick |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1538412382 PECOS PAC ID: 7315173747 Enrollment ID: I20131113001499 |
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