Provider Demographics
NPI:1669420923
Name:NEUROPSYCHOLOGY ASSOCIATES, PA
Entity type:Organization
Organization Name:NEUROPSYCHOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD ABPN
Authorized Official - Phone:701-297-7588
Mailing Address - Street 1:1220 MAIN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8233
Mailing Address - Country:US
Mailing Address - Phone:701-297-7588
Mailing Address - Fax:701-364-2256
Practice Address - Street 1:1220 MAIN AVE STE 100
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8201
Practice Address - Country:US
Practice Address - Phone:701-297-7588
Practice Address - Fax:701-364-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND226174400000X
ND171174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12261Medicaid
ND23179Medicare ID - Type UnspecifiedRODNEY SWENSON
NDR02273Medicare UPIN
NDN711207Medicare PIN
ND22922Medicare ID - Type UnspecifiedSUSAN THOMPSON
ND17019Medicare ID - Type UnspecifiedRODNEY SWENSON
ND12261Medicaid