Organization
BROOKINGS NEUROPSYCHOLOGY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS RAUBY SHAFFER PHD (CLINIC MANAGER)
(605) 692-6367
Entity
Organization
Contact information
Practice address
928 4TH ST, SUITE 6, BROOKINGS, SD 57006-2171
(605) 692-6367
(605) 692-1883
Mailing address
PO BOX 931, BROOKINGS, SD 57006-0931
(605) 692-6367
(605) 692-1883
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
472
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6552660
—
SD
01
—
S102729
MEDICARE PTAN/ID
—
Enumeration date
09/17/2012
Last updated
09/17/2012
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