Provider Demographics
NPI:1033749163
Name:NEUROCALM, LLC
Entity Type:Organization
Organization Name:NEUROCALM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD; MBA
Authorized Official - Phone:612-284-3990
Mailing Address - Street 1:2011 KENWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2304
Mailing Address - Country:US
Mailing Address - Phone:612-227-1990
Mailing Address - Fax:612-314-7041
Practice Address - Street 1:2011 KENWOOD PKWY
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2304
Practice Address - Country:US
Practice Address - Phone:612-227-1990
Practice Address - Fax:612-314-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty