1528282597 NPI number — CENTER FOR NEUROPSYCHOLOGY & LEARNING

Table of content: (NPI 1528282597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528282597 NPI number — CENTER FOR NEUROPSYCHOLOGY & LEARNING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR NEUROPSYCHOLOGY & LEARNING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTER FOR NEUROPSYCHOLOGY, LEARNING & DEVELOPMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528282597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5864 INTERFACE DR STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48103-9514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-994-9466
Provider Business Mailing Address Fax Number:
734-994-9465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5864 INTERFACE DR STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48103-9514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-994-9466
Provider Business Practice Location Address Fax Number:
734-994-9465
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAUER
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
734-994-9466

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  6301007927 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 6301007927 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0700X , with the licence number: 6301007927 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 6301007927 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: 6301007927 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TF0000X , with the licence number: 6301007927 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TM1800X , with the licence number: 6301007927 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TP2701X , with the licence number: 6301007927 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 6801085187 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6801085187 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 680H112930 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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