Healthcare Provider Details

I. General information

NPI: 1063798569
Provider Name (Legal Business Name): LIZHAO WANG NEUROPSYCHOLOGICAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SW 8TH AVE
TOPEKA KS
66606-1632
US

IV. Provider business mailing address

5634 SW CLARION LAKES DR
TOPEKA KS
66610-1627
US

V. Phone/Fax

Practice location:
  • Phone: 785-232-8542
  • Fax: 785-478-1791
Mailing address:
  • Phone: 785-228-1481
  • Fax: 785-478-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number830
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number830
License Number StateKS

VIII. Authorized Official

Name: LIZHAO WANG
Title or Position: CLINICAL NEUROPSYCHOLOGIST
Credential: PH.D.
Phone: 785-232-8542