Provider Demographics
NPI:1467779330
Name:KEARNEY NEUROPSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:KEARNEY NEUROPSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIDDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:308-234-6230
Mailing Address - Street 1:4111 4TH AVE STE 32
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2884
Mailing Address - Country:US
Mailing Address - Phone:308-234-6230
Mailing Address - Fax:308-237-4792
Practice Address - Street 1:4111 4TH AVE STE 32
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2884
Practice Address - Country:US
Practice Address - Phone:308-234-6230
Practice Address - Fax:308-237-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE338261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)