Provider Demographics
NPI:1003542069
Name:NEURO PLLC
Entity Type:Organization
Organization Name:NEURO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ODLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LP, ABPP
Authorized Official - Phone:320-491-8233
Mailing Address - Street 1:15600 36TH AVE N STE 140
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3372
Mailing Address - Country:US
Mailing Address - Phone:320-491-8233
Mailing Address - Fax:612-392-7974
Practice Address - Street 1:15600 36TH AVE N STE 140
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-3372
Practice Address - Country:US
Practice Address - Phone:763-308-5772
Practice Address - Fax:612-392-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty