FORT WAYNE NEUROPSYCHOLOGY LLC (NPI# 1871032862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871032862 |
| Entity Type | Organization |
| Organization Name | FORT WAYNE NEUROPSYCHOLOGY LLC |
| Practice Address |
4306 E State Blvd Fort Wayne IN 46815-6915 |
| Practice Telephone | 2604603100 |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2017-02-23 |
| Authorized Official Name | TASHA H. WILLIAMS (VICE PRESIDENT) |
| Authorized Official Telephone | 2604148629 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| Y | 103G00000X | Clinical Neuropsychologist | Behavioral Health & Social Service Providers |
| Street Address |
4306 E STATE BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46815-6915 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831710201 | Margaret R Wardlow | Social Worker | 4306 E State Blvd, Fort Wayne, IN 46815-6915 | 2020-04-27 |
| 1255974804 | Lori Stock | Social Worker | 4306 E State Blvd, Fort Wayne, IN 46815-6915 | 2019-10-25 |
| 1447891312 | Kelly L Hoover | Psychologist | 4306 E State Blvd, Fort Wayne, IN 46815-6915 | 2019-10-02 |
| 1366911000 | Margarita M Nogin | Clinical Neuropsychologist | 4306 E State Blvd, Fort Wayne, IN 46815-6915 | 2018-11-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306305438 | Sullivan Services, Inc. | In Home Supportive Care | 2789-b Maplecrest Rd, Fort Wayne, IN 46815 | 2019-03-18 |
| 1598250144 | Altermease Gleason | Massage Therapist | 3406 Thames Drive, Fort Wayne, IN 46815 | 2018-06-26 |
| 1881000222 | Denise Sparks | Specialist | 6415 Benham Drive, Fort Wayne, IN 46815 | 2014-07-07 |
| 1962823138 | Chad Distelrath | Physical Therapy Assistant | 1717 Maplecrest Rd, Apt 112, Fort Wayne, IN 46815 | 2013-12-13 |
| 1689943409 | Kendall Joan Labrash | Physical Therapist | 4251 Lahmeyer Rd., Fort Wayne, IN 46815 | 2011-12-22 |
| 1801179718 | Jayson Laube | Pharmacist | 6201 Stellhorn, Fort Wayne, IN 46815 | 2011-09-27 |
| 1720294432 | Muscle Therapy Clinic LLC | Massage Therapist | 6409 Georgetown North Blvd, Fort Wayne, IN 46815 | 2007-05-16 |
| 1427186436 | Legoras Conture Fashions | Prosthetic/Orthotic Supplier | 3316 Inwood Drive, Fort Wayne, IN 46815 | 2007-03-01 |
| 1932252772 | Fort Wayne Smiles PC | Dentist | 2031 Reed Road, Fort Wayne, IN 46815 | 2007-01-18 |
| 1811078538 | Timothy Doody Lynch | Dentist | 4207 Hobson Court, Fort Wayne, IN 46815 | 2006-10-18 |
| Find all providers in zip 46815 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619275807 | Renee Elizabeth Buskirk | Clinical Neuropsychologist | 11143 Parkview Plaza Dr Ste 207, Fort Wayne, IN 46845-1728 | 2011-03-11 |
| 1780681254 | Frances R. Goff | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1730 | 2005-06-30 |
| 1972508471 | Matthew Paul Ziccardi | Clinical Neuropsychologist | 2200 Randallia Dr, Fort Wayne, IN 46805 | 2005-06-20 |
| 1366911000 | Margarita M Nogin | Clinical Neuropsychologist | 4306 E State Blvd, Fort Wayne, IN 46815-6915 | 2018-11-23 |
| 1699196519 | Erin Miles | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2013-12-19 |
| 1164860052 | Jacob Thomas Lutz | Clinical Neuropsychologist | 11104 Parkview Circle Dr Ste 110, Fort Wayne, IN 46845-1673 | 2013-06-13 |
| 1689995334 | Allied Physicians Inc | Clinical Neuropsychologist | 7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2010-06-17 |
| 1669701793 | Christina M. Stemmler | Clinical Neuropsychologist | 11104 Parkview Circle Dr, Ste 110, Fort Wayne, IN 46845-1730 | 2009-12-21 |
| 1841524105 | Nivonne Thompson | Clinical Neuropsychologist | 2121 Lake Ave, Fort Wayne, IN 46805-5100 | 2009-09-18 |
| 1205098100 | Allied Physicians Inc | Clinical Neuropsychologist | 7956 W Jefferson Blvd, Fort Wayne, IN 46804-4140 | 2008-07-01 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46815 |
Please comment or provide details below to improve the information on FORT WAYNE NEUROPSYCHOLOGY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.