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General NPI Number Information
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NPI Number | 1639933641
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Entity Type | Organization
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Legal Business Name | LILAC CITY NEUROPSYCHOLOGY PLLC
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Dates
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Enumeration Date | 02/09/2024
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 1403 S GRAND BLVD STE 203N
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City | SPOKANE
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State | WA
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Zip | 99203-2200
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Country | US
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Telephone | 509-779-8065
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Fax | 844-779-0338
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Provider Business Mailing Address
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Address Line | 1403 S GRAND BLVD STE 203N
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City | SPOKANE
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State | WA
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Zip | 99203-2200
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Country | US
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Telephone | 509-779-8065
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Fax | 844-779-0338
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Authorized Official
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Title or Position | OWNER
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Name | VIRGINIA M. KLEMAN
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Credential |
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Telephone | 509-779-8065
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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 |
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License Number State |
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