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General NPI Number Information
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NPI Number | 1649640335
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Entity Type | Organization
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Legal Business Name | NORTHWEST NEUROHEALTH LLC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 501 N. VILLA ROAD
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City | NEWBERG
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State | OR
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Zip | 97140
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Country | US
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Telephone | 503-819-7969
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Fax | 503-536-6562
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Provider Business Mailing Address
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Address Line | 515 VILLA RD
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City | NEWBERG
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State | OR
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Zip | 97132-1832
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Country | US
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Telephone | 503-819-7969
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ROBERT JAMES WENIGER
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Credential | PSY. D.
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Telephone | 503-819-7969
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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 | 2035
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License Number State | OR
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