Healthcare Provider Details

I. General information

NPI: 1053594853
Provider Name (Legal Business Name): EAST SLOPE NEUROPSYCHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S 40TH AVE SUITE 24
YAKIMA WA
98908-3868
US

IV. Provider business mailing address

1015 S 40TH AVE SUITE 24
YAKIMA WA
98908-3806
US

V. Phone/Fax

Practice location:
  • Phone: 509-966-2961
  • Fax: 509-966-2318
Mailing address:
  • Phone: 509-966-2961
  • Fax: 509-966-2318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberPY2939
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberPY 2939
License Number StateWA

VIII. Authorized Official

Name: DR. JANE KUCERA THOMPSON
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 509-966-2961