Organization
RUSH PEDIATRIC NEUROPSYCHOLOGY, PLLC
Active
Organization
RUSH PEDIATRIC NEUROPSYCHOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANA J RUSH PHD (OWNER)
(616) 780-0590
Entity
Organization
Contact information
Practice address
412 PLYMOUTH AVE NE, GRAND RAPIDS, MI 49505-6028
(616) 780-0590
(616) 984-4559
Mailing address
412 PLYMOUTH AVE NE, GRAND RAPIDS, MI 49505-6028
(616) 780-0590
(616) 984-4559
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103T00000X
Psychologist
—
—
Other
Enumeration date
11/02/2022
Last updated
05/12/2023
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