| Path Neuropsychology, Llc | |
|
2812 Mack Rd Fairfield OH 45014-5130 | |
| (513) 429-9886 | |
| Not Available |
| Full Name | Path Neuropsychology, Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 2812 Mack Rd, Fairfield, Ohio |
| Authorized Official Name and Position | Shawna Jacob (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5138135327 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Path Neuropsychology, Llc 2812 Mack Rd Fairfield OH 45014-5130 Ph: (513) 813-5327 | Path Neuropsychology, Llc 2812 Mack Rd Fairfield OH 45014-5130 Ph: (513) 429-9886 |
| NPI Number | 1427763945 |
|---|---|
| Provider Enumeration Date | 01/18/2023 |
| Last Update Date | 03/22/2023 |
| Certification Date | 03/22/2023 |
| Medicare PECOS PAC ID | 5698140275 |
|---|---|
| Medicare Enrollment ID | O20230413000349 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427763945 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Audrey Greene |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1871016634 PECOS PAC ID: 0042582009 Enrollment ID: I20170829001198 |
| Provider Name | Shawna Jacob |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104485929 PECOS PAC ID: 6002142965 Enrollment ID: I20190730002992 |
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