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General NPI Number Information
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NPI Number | 1447508072
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Entity Type | Organization
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Legal Business Name | KEIFER NEUROPSYCHOLOGY, LLC
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 10730 W 143RD ST SUITE 37
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City | ORLAND PARK
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State | IL
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Zip | 60462-1939
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Country | US
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Telephone | 319-321-5794
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Fax |
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Provider Business Mailing Address
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Address Line | 14730 CENTRAL AVE APT. A213
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City | OAK FOREST
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State | IL
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Zip | 60452-1269
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Country | US
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Telephone | 319-321-5794
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | EKATERINA KEIFER
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Credential | PHD
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Telephone | 319-321-5794
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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 | 071.008402
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License Number State | IL
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