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General NPI Number Information
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NPI Number | 1316089451
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN NEUROPSYCHOLOGY PLLC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1648 ELLIS ST #302
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City | BOZEMAN
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State | MT
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Zip | 59715-8810
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Country | US
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Telephone | 406-582-4466
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Fax | 406-587-1513
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Provider Business Mailing Address
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Address Line | 1648 ELLIS ST #302
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City | BOZEMAN
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State | MT
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Zip | 59715-8810
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Country | US
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Telephone | 406-582-4466
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Fax | 406-587-1513
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Authorized Official
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Title or Position | OWNER MEMBER
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Name | DR. JEFFREY MICHAEL CORY
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Credential | PH.D.
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Telephone | 406-582-4466
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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 | 368
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License Number State | MT
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