Healthcare Provider Details

I. General information

NPI: 1275930919
Provider Name (Legal Business Name): GLASSMAN NEUROPSYCHOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 S 102ND ST SUITE 270
WEST ALLIS WI
53227-2466
US

IV. Provider business mailing address

2448 S 102ND ST SUITE 270
WEST ALLIS WI
53227-2466
US

V. Phone/Fax

Practice location:
  • Phone: 414-444-9811
  • Fax: 414-444-9822
Mailing address:
  • Phone: 414-444-9811
  • Fax: 414-444-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1653-57
License Number StateWI

VIII. Authorized Official

Name: DR. NATHAN D GLASSMAN
Title or Position: OWNER
Credential: PHD
Phone: 414-444-9811