MEDICARE: ESTES NEUROPSYCHOLOGY, LLC

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	20042177A	IN

General Provider Information

NPI Number	:	1669641114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTES NEUROPSYCHOLOGY, LLC

Provider Business Mailing Address
First Line	:	1655 N GLADSTONE AVE STE D
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5380
Country	:	US
Telephone Number	:	812-376-7981
Fax Number	:	812-376-8584

Provider Business Practice Location Address
First Line	:	1655 N GLADSTONE AVE STE D
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5380
Country	:	US
Telephone Number	:	812-376-7981
Fax Number	:	812-376-8584

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DONELLA MARIE TURNER
Credential	:
Telephone Number	:	812-376-7981

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	02/28/2008

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