NPI | 1063568210 |
---|---|
Doing Business As | MICHIGAN AVENUE NEUROPSYCHOLOGISTS |
Entity Type | Organization |
Authorized Contact | DIANA SUSAN GOLDSTEIN President & CEO 312-212-1776 |
Organization Subpart ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: IL 071006006) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IN 20041441A) |
103TA0700X Psychologist, Adult Development & Aging (Licence: IL 071006006) | |
103TA0700X Psychologist, Adult Development & Aging (Licence: IN 20041441A) | |
103TC0700X Psychologist, Clinical (Licence: IL 071006006) | |
103TC0700X Psychologist, Clinical (Licence: IN 20041441A) | |
103T00000X Psychologist (Licence: IL 071006006) | |
103T00000X Psychologist (Licence: IN 20041441A) | |
Enumeration Date | 2007-01-28 |
Last Update Date | 2009-06-08 |