Organization
MERIDIAN NEUROPSYCHOLOGY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON SOUTHWICK PHD (MANAGER)
(208) 895-9852
Entity
Organization
Contact information
Practice address
3061 S MERIDIAN RD, STE 100, MERIDIAN, ID 83642-7962
(208) 895-9852
(208) 629-1231
Mailing address
3597 E MONARCH SKY LN STE 240, MERIDIAN, ID 83646-1055
(208) 391-7274
(208) 629-1231
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY-202728
ID
103TC0700X
Clinical Psychologist
PSY-202728
ID
Other
Enumeration date
10/20/2014
Last updated
05/18/2024
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