MEDICARE: NEUROPSYCHOLOGICAL CONSULTANTS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1407834575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROPSYCHOLOGICAL CONSULTANTS, INC

Provider Business Mailing Address
First Line	:	6435 W JEFFERSON BLVD
Second Line	:	PMB 145
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6203
Country	:	US
Telephone Number	:	260-409-2099
Fax Number	:

Provider Business Practice Location Address
First Line	:	3470 STELLHORN RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4630
Country	:	US
Telephone Number	:	260-409-2099
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HEIDI L MUSGRAVE
Credential	:	PH.D.
Telephone Number	:	260-409-2099

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	08/22/2020

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