Provider Demographics
NPI:1144379678
Name:NEUROPSYCHOLOGY SPECIALISTS
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-996-1200
Mailing Address - Street 1:3420 E SHEA BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3345
Mailing Address - Country:US
Mailing Address - Phone:602-996-1200
Mailing Address - Fax:602-996-4501
Practice Address - Street 1:3420 E SHEA BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3345
Practice Address - Country:US
Practice Address - Phone:602-996-1200
Practice Address - Fax:602-996-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3265103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ445967Medicaid