Organization
FORT WAYNE NEUROPSYCHOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHA H. WILLIAMS PH.D. (VICE PRESIDENT)
(260) 414-8629
Entity
Organization
Contact information
Practice address
4306 E STATE BLVD, FORT WAYNE, IN 46815-6915
(260) 460-3100
Mailing address
4306 E STATE BLVD, FORT WAYNE, IN 46815-6915
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
02/23/2017
Last updated
02/23/2017
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