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General NPI Number Information
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NPI Number | 1710964218
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Entity Type | Organization
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Legal Business Name | PEDIATRIC NEUROPSYCHOLOGY SERVICES, P.C.
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 7200 FRANCE AVE S SUITE 128
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City | EDINA
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State | MN
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Zip | 55435-4300
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Country | US
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Telephone | 952-831-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 4120 AVONDALE ST
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City | MINNETONKA
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State | MN
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Zip | 55345-1805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVIDA GOLDMAN
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Credential | PH.D., L.P.
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Telephone | 952-831-7400
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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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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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