Provider Demographics
NPI:1114188208
Name:LINDA D RICE PA
Entity Type:Organization
Organization Name:LINDA D RICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-312-7916
Mailing Address - Street 1:PO BOX 2257
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-0357
Mailing Address - Country:US
Mailing Address - Phone:847-983-3515
Mailing Address - Fax:219-926-3524
Practice Address - Street 1:5250 OLD ORCHARD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4460
Practice Address - Country:US
Practice Address - Phone:847-983-3515
Practice Address - Fax:219-926-3524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2428103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty