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General NPI Number Information
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NPI Number | 1649467267
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN NEUROPSYCHOLOGY INSTITUTE, S.C
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 680 N LAKE SHORE DR SUITE 925
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-664-6860
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Fax | 857-295-8745
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Provider Business Mailing Address
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Address Line | PO BOX 11690
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City | CHICAGO
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State | IL
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Zip | 60611-0690
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Country | US
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Telephone | 773-735-2110
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Fax | 773-735-4238
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. FREDA N LINDSEY
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Credential |
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Telephone | 773-735-2110
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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 | 071006935
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License Number State | IL
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