Provider Demographics
NPI:1669850681
Name:NEUROPSYCHOLOGICAL SERVICES OF THE SOUTH SOUND LLC
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGICAL SERVICES OF THE SOUTH SOUND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAHMER-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-709-0601
Mailing Address - Street 1:2620 R W JOHNSON RD SW STE 204
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6133
Mailing Address - Country:US
Mailing Address - Phone:360-709-0601
Mailing Address - Fax:360-528-2080
Practice Address - Street 1:2620 R W JOHNSON RD SW STE 204
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-6133
Practice Address - Country:US
Practice Address - Phone:360-709-0601
Practice Address - Fax:360-528-2080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty