| 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 |