MEDICARE: CLINICAL NEUROSCIENCE ASSOCIATES, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1538267414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL NEUROSCIENCE ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	7009 NAPLES WAY
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72916-8701
Country	:	US
Telephone Number	:	479-434-2743
Fax Number	:	844-454-8351

Provider Business Practice Location Address
First Line	:	320 N GREENWOOD AVE
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72901-3454
Country	:	US
Telephone Number	:	479-434-2743
Fax Number	:	844-454-8351

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JON M GUSTAFSON
Credential	:	MD
Telephone Number	:	479-434-2743

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	09/14/2025

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