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General NPI Number Information
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NPI Number | 1902456569
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Entity Type | Organization
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Legal Business Name | NEUROPSYCHOLOGICAL SERVICES OF SOUTHEASTERN WISCONSIN,LTD
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 200 S EXECUTIVE DR STE 101
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City | BROOKFIELD
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State | WI
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Zip | 53005-4216
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Country | US
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Telephone | 262-780-1592
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Fax | 262-303-4161
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Provider Business Mailing Address
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Address Line | 1132 S WATERVILLE LAKE RD
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City | OCONOMOWOC
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State | WI
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Zip | 53066-8401
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Country | US
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Telephone | 262-751-4499
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Fax | 262-303-4161
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Authorized Official
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Title or Position | NEUROPSYCHOLOGIST/OWNER
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Name | PAMELA MCMURRAY
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Credential | PHD
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Telephone | 262-751-4499
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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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