| Neuropsychological Services Of Oregon, Llc | |
|
170 Melton Rd Creswell OR 97426-9453 | |
| (541) 306-6456 | |
| (541) 647-1580 |
| Full Name | Neuropsychological Services Of Oregon, Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 170 Melton Rd, Creswell, Oregon |
| Authorized Official Name and Position | Tracy Kreiling (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5413066456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neuropsychological Services Of Oregon, Llc 170 Melton Rd Creswell OR 97426-9453 Ph: (541) 306-6456 | Neuropsychological Services Of Oregon, Llc 170 Melton Rd Creswell OR 97426-9453 Ph: (541) 306-6456 |
| NPI Number | 1164820478 |
|---|---|
| Provider Enumeration Date | 12/18/2014 |
| Last Update Date | 10/30/2024 |
| Certification Date | 10/30/2024 |
| Medicare PECOS PAC ID | 1658697701 |
|---|---|
| Medicare Enrollment ID | O20150306002286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164820478 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 2524 (Oregon) | Primary |
| 103T00000X | Psychologist | 2524 (Oregon) | Secondary |
| Provider Name | Tracy N Kreiling |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1659682177 PECOS PAC ID: 8123212701 Enrollment ID: I20150306002291 |
| Provider Name | Andrea Marie Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194255877 PECOS PAC ID: 7719216431 Enrollment ID: I20190905003099 |