Provider Demographics
NPI:1093542904
Name:AMETHYST NEUROPSYCHOLOGY PLLC
Entity type:Organization
Organization Name:AMETHYST NEUROPSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:618-680-0317
Mailing Address - Street 1:4505 N ILLINOIS ST STE 7
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1500
Mailing Address - Country:US
Mailing Address - Phone:618-680-0317
Mailing Address - Fax:
Practice Address - Street 1:4505 N ILLINOIS ST STE 7
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1500
Practice Address - Country:US
Practice Address - Phone:618-680-0317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty