Organization
SOUTHERN ILLINOIS NEUROPSYCHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP RUPPERT PHD (OWNER)
(618) 391-4021
Entity
Organization
Contact information
Practice address
60 S STATE ROUTE 157, EDWARDSVILLE, IL 62025
(618) 391-4021
Mailing address
1 OAK DR UNIT 352, MARYVILLE, IL 62062-7026
(618) 391-4021
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
071009269
IL
Other
Enumeration date
01/03/2018
Last updated
02/10/2022
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