| Midwest Neuropsychology, Pllc | |
|
3301 30th Ave S Ste 101 Grand Forks ND 58201-6009 | |
| (701) 780-9700 | |
| (701) 780-9709 |
| Full Name | Midwest Neuropsychology, Pllc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 3301 30th Ave S Ste 101, Grand Forks, North Dakota |
| Authorized Official Name and Position | Susan J Thompson (NEUROPSYCHOLOGIST) |
| Authorized Official Contact | 7017809700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Midwest Neuropsychology, Pllc 3301 30th Ave S Ste 101 Grand Forks ND 58201-6009 Ph: (701) 780-9700 | Midwest Neuropsychology, Pllc 3301 30th Ave S Ste 101 Grand Forks ND 58201-6009 Ph: (701) 780-9700 |
| NPI Number | 1699078626 |
|---|---|
| Provider Enumeration Date | 12/14/2010 |
| Last Update Date | 04/18/2014 |
| Medicare PECOS PAC ID | 9234319229 |
|---|---|
| Medicare Enrollment ID | O20110208000853 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699078626 | NPI | - | NPPES |
| N715763 | Other | ND | MEDICARE PART B |
| 000015495 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Susan J Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396968061 PECOS PAC ID: 7517154487 Enrollment ID: I20101206000375 |
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