Provider Demographics
NPI:1689019549
Name:BEND NEUROPSYCHOLOGY CLINIC, LLC
Entity Type:Organization
Organization Name:BEND NEUROPSYCHOLOGY CLINIC, LLC
Other - Org Name:WENDY LAAKMANN, PH.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:LAAKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-241-2228
Mailing Address - Street 1:61644 BELMORE LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-5007
Mailing Address - Country:US
Mailing Address - Phone:541-241-2228
Mailing Address - Fax:
Practice Address - Street 1:131 NW HAWTHORNE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2929
Practice Address - Country:US
Practice Address - Phone:541-241-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2302251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health