Provider Demographics
NPI:1205032810
Name:CLINICAL NEUROPSYCHOLOGY SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:CLINICAL NEUROPSYCHOLOGY SPECIALISTS, PLLC
Other - Org Name:DR. LAUREN DAWSON
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-996-1301
Mailing Address - Street 1:226 N KUAKINI ST
Mailing Address - Street 2:SUITE 168
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2488
Mailing Address - Country:US
Mailing Address - Phone:602-996-1301
Mailing Address - Fax:602-773-6615
Practice Address - Street 1:226 N KUAKINI ST
Practice Address - Street 2:SUITE 168
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2488
Practice Address - Country:US
Practice Address - Phone:602-996-1301
Practice Address - Fax:602-773-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3310103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ106272Medicare ID - Type UnspecifiedMEDICARE GROUP ID