MEDICARE: FORT WAYNE NEUROPSYCHOLOGY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	1041C0700X	Clinical Social Worker
3	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1871032862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT WAYNE NEUROPSYCHOLOGY LLC

Provider Business Mailing Address
First Line	:	4306 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4306 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6915
Country	:	US
Telephone Number	:	260-460-3100
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	TASHA H. WILLIAMS
Credential	:	PH.D.
Telephone Number	:	260-414-8629

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	02/23/2017

Similar Medicare Providers

1366911000 — MARGARITA M NOGIN PH.D., HSPP
Practice Location Address:

4306 E STATE BLVD
FORT WAYNE, IN
46815-6915

Practice Phone: 260-460-3203
Practice Fax:

1447891312 — KELLY L HOOVER PH.D., HSPP
Practice Location Address:

4306 E STATE BLVD
FORT WAYNE, IN
46815-6915

Practice Phone: 260-460-3203
Practice Fax: 260-460-3271

1255974804 — LORI STOCK
Practice Location Address:

4306 E STATE BLVD
FORT WAYNE, IN
46815-6915

Practice Phone: 260-460-3203
Practice Fax:

1912686627 — CATHRINE SHORT PH.D.
Practice Location Address:

4306 E STATE BLVD
FORT WAYNE, IN
46815-6915

Practice Phone: 260-460-3203
Practice Fax:

1760981013 — HEATHER ROCHELLE PALMER MT-BC
Practice Location Address:

10317 LAKE TAHOE DR
FORT WAYNE, IN
46804-6915

Practice Phone: 260-437-3083
Practice Fax:

1831710201 — MARGARET R WARDLOW
Practice Location Address:

2121 LAKE AVENUE
FORT WAYNE, IN
46805-6915

Practice Phone: 260-715-8256
Practice Fax:

Directions to “FORT WAYNE NEUROPSYCHOLOGY LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.