Provider Demographics
NPI:1013884766
Name:AEROSPACE NEUROPSYCHOLOGY SERVICES
Entity type:Organization
Organization Name:AEROSPACE NEUROPSYCHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP
Authorized Official - Phone:801-815-5479
Mailing Address - Street 1:476 HERITAGE PARK BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5679
Mailing Address - Country:US
Mailing Address - Phone:202-615-8813
Mailing Address - Fax:202-750-0425
Practice Address - Street 1:476 HERITAGE PARK BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5679
Practice Address - Country:US
Practice Address - Phone:202-615-8813
Practice Address - Fax:202-750-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-18
Last Update Date:2025-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty