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General NPI Number Information
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NPI Number | 1013290675
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Entity Type | Organization
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Legal Business Name | ACADEMIC SOLUTIONS OF MICHIANA
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 2012 IRONWOOD CIR
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City | SOUTH BEND
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State | IN
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Zip | 46635-1888
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Country | US
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Telephone | 574-273-2743
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Fax | 574-273-2746
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Provider Business Mailing Address
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Address Line | 2012 IRONWOOD CIR
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City | SOUTH BEND
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State | IN
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Zip | 46635-1888
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Country | US
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Telephone | 574-273-2743
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Fax | 574-273-2746
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. DONNA TURNER-CAMPBELL
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Credential | PHD
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Telephone | 574-272-2743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 20042517A
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License Number State | IN
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