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General NPI Number Information
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NPI Number | 1285865378
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Entity Type | Organization
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Legal Business Name | ANPS-IN LLC
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Dates
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Enumeration Date | 08/06/2009
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 908 ROOSEVELT RD SUITE K
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City | VALPARAISO
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State | IN
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Zip | 46383-4375
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Country | US
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Telephone | 219-462-0246
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Fax | 219-462-5032
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Provider Business Mailing Address
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Address Line | 908 ROOSEVELT RD SUITE K
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City | VALPARAISO
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State | IN
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Zip | 46383-4375
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Country | US
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Telephone | 219-462-0246
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Fax | 219-462-5032
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST
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Name | JUDITH DEGRAZIA HARRINGTON
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Credential | PHD.
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Telephone | 702-650-0590
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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 | 20042329A
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License Number State | IN
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