Provider Demographics
NPI:1609267251
Name:NEUROPSYCHOLOGY DIAGNOSTIC CENTER LLC.
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGY DIAGNOSTIC CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-403-9000
Mailing Address - Street 1:16001 108TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8788
Mailing Address - Country:US
Mailing Address - Phone:708-403-9000
Mailing Address - Fax:708-403-9988
Practice Address - Street 1:16001 108TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-8788
Practice Address - Country:US
Practice Address - Phone:708-403-9000
Practice Address - Fax:708-403-9988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003840103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty