=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750057972
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILVERLEAF NEUROPSYCHOLOGICAL SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2021
-----------------------------------------------------
Last Update Date | 08/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 E MISSOURI AVE STE 640
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85014-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-492-2372
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2718 E BIGHORN AVE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85048-8984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-492-2372
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NEUROPSYCHOLOGIST
-----------------------------------------------------
Name | KAREN L CHANEY
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 602-492-2372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103G00000X
-----------------------------------------------------
Taxonomy Name | Clinical Neuropsychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------