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General NPI Number Information
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NPI Number | 1023721511
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Entity Type | Organization
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Legal Business Name | CNLD NEUROPSYCHOLOGY PC
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Dates
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Enumeration Date | 12/30/2022
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 5864 INTERFACE DR STE D
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City | ANN ARBOR
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State | MI
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Zip | 48103-9514
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Country | US
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Telephone | 734-994-9466
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Fax | 734-994-9465
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Provider Business Mailing Address
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Address Line | 5864 INTERFACE DR STE D
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City | ANN ARBOR
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State | MI
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Zip | 48103-9514
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Country | US
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Telephone | 734-994-9466
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Fax | 734-994-9465
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DR. ROGER E. LAUER
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Credential | PH.D.
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Telephone | 734-994-9466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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