Provider Demographics
NPI:1639507205
Name:VELTKAMP NEUROPSYCHOLOGY
Entity Type:Organization
Organization Name:VELTKAMP NEUROPSYCHOLOGY
Other - Org Name:VELTKAMP NEUROPSYCHOLOGY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VELTKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-676-7445
Mailing Address - Street 1:1610 GROVER ST STE B10
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1539
Mailing Address - Country:US
Mailing Address - Phone:360-676-7445
Mailing Address - Fax:360-733-4339
Practice Address - Street 1:1610 GROVER ST STE B10
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1539
Practice Address - Country:US
Practice Address - Phone:360-676-7445
Practice Address - Fax:360-733-4339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB23603Medicare UPIN