Provider Demographics
NPI:1790356889
Name:CENTER FOR NEUROPSYCHOLOGICAL ASSESSMENT, PLLC
Entity Type:Organization
Organization Name:CENTER FOR NEUROPSYCHOLOGICAL ASSESSMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-415-8781
Mailing Address - Street 1:645 N MICHIGAN AVE STE 803
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5123
Mailing Address - Country:US
Mailing Address - Phone:630-415-8781
Mailing Address - Fax:
Practice Address - Street 1:645 N MICHIGAN AVE STE 803
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5123
Practice Address - Country:US
Practice Address - Phone:630-415-8781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty