Provider Demographics
NPI:1649640335
Name:NORTHWEST NEUROHEALTH LLC
Entity type:Organization
Organization Name:NORTHWEST NEUROHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WENIGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:503-819-7969
Mailing Address - Street 1:515 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1832
Mailing Address - Country:US
Mailing Address - Phone:503-819-7969
Mailing Address - Fax:
Practice Address - Street 1:501 N. VILLA ROAD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97140
Practice Address - Country:US
Practice Address - Phone:503-819-7969
Practice Address - Fax:503-536-6562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2035103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty