PEDIATRIC NEUROPSYCHOLOGY SERVICES, P.C.
Clinical Neuropsychologist
Edina, Minnesota
Provider NPI: 1710964218
Organization Information:Organization Name: PEDIATRIC NEUROPSYCHOLOGY SERVICES, P.C.
Organization is not Subpart
Authorized Official: DAVIDA GOLDMAN OWNER 952-8317400
Practice Location:
7200 FRANCE AVE S SUITE 128 EDINA, MN 55435 US
Tel: 952-831-7400 Fax: --
Business Mailing Address:
4120 AVONDALE ST MINNETONKA, MN 55345 US
Tel: -- Fax: --
Entity Type: Organization
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Organization is not Subpart
Authorized Official: DAVIDA GOLDMAN OWNER 952-8317400
Practice Location:
7200 FRANCE AVE S SUITE 128 EDINA, MN 55435 US
Tel: 952-831-7400 Fax: --
Business Mailing Address:
4120 AVONDALE ST MINNETONKA, MN 55345 US
Tel: -- Fax: --
Entity Type: Organization
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
X | 103G00000X | Behavioral Health & Social Service Providers Clinical Neuropsychologist | ||
X | 103T00000X | Behavioral Health & Social Service Providers Psychologist | ||
X | 103TC0700X | Behavioral Health & Social Service Providers Psychologist |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
MEDICA | 61-90675 | MN | 01 |
HEALTHPARTNERS | 116883 | MN | 01 |
BLUE CROSS BLUE SHIELD | 337G4PE | MN | 01 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin