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General NPI Number Information
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NPI Number | 1497010706
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Entity Type | Organization
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Legal Business Name | LEAH B. SCHOCK PHD, LLC
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 975 SW COLORADO AVE STE 100
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City | BEND
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State | OR
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Zip | 97702-3155
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Country | US
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Telephone | 541-678-5164
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Fax | 541-678-5017
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Provider Business Mailing Address
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Address Line | 975 SW COLORADO AVE STE 100
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City | BEND
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State | OR
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Zip | 97702-3155
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Country | US
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Telephone | 541-678-5164
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Fax | 541-678-5017
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Authorized Official
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Title or Position | MEMBER
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Name | DR. LEAH B SCHOCK
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Credential | PH.D.
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Telephone | 541-678-5164
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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 | 1492
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License Number State | OR
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