=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770693889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEROPSYCHOLOGY CONSULTANTS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 11/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4030 MT CARMEL TOBASCO RD STE 306D
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-233-3500
-----------------------------------------------------
Fax | 513-233-3501
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 30264
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-233-3500
-----------------------------------------------------
Fax | 513-233-3501
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SUZANNE M NORMAN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 513-233-3500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 5372
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------