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General NPI Number Information
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NPI Number | 1477446771
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Entity Type | Organization
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Legal Business Name | FORENSIC NEUROSCIENCE CONSULTANTS LLC
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 2030 NW RALEIGH ST
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City | PORTLAND
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State | OR
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Zip | 97209-2390
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Country | US
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Telephone | 630-935-1548
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 NW RALEIGH ST APT 403
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City | PORTLAND
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State | OR
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Zip | 97209-2374
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Country | US
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Telephone | 630-935-1548
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID MASOLAK
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Credential | MD
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Telephone | 630-935-1548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0005X
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Taxonomy Name | Neurodevelopmental Disabilities Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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