MEDICARE: DR. MICHELLE K CONOVER PH. D.

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	103G00000X	Clinical Neuropsychologist	PSY 21871	CA

General Provider Information

NPI Number	:	1619126125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE K CONOVER PH. D.

Provider Business Mailing Address
First Line	:	5950 CANOGA AVE STE 100
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-5052
Country	:	US
Telephone Number	:	818-340-7700
Fax Number	:	818-340-7701

Provider Business Practice Location Address
First Line	:	5950 CANOGA AVE STE 100
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-5052
Country	:	US
Telephone Number	:	818-340-7700
Fax Number	:	818-340-7701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	05/09/2024

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