Healthcare Provider Details

I. General information

NPI: 1407102742
Provider Name (Legal Business Name): NORMAN NEUROPSYCHOLOGY ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 11/02/2012
Certification Date:
Deactivation Date: 08/17/2012
Reactivation Date: 11/02/2012

III. Provider practice location address

3280 MARSHALL AVE
NORMAN OK
73072-8022
US

IV. Provider business mailing address

3280 MARSHALL AVE
NORMAN OK
73072-8022
US

V. Phone/Fax

Practice location:
  • Phone: 405-818-7768
  • Fax:
Mailing address:
  • Phone: 405-818-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1147
License Number StateOK

VIII. Authorized Official

Name: DR. JOHN F LINCK
Title or Position: CLINICAL NEUROPSYCHOLOGIST/MANAGER
Credential: PH.D.
Phone: 405-818-7768