| Neuropsychology Clinic | |
|
2804 20th Ave Northport AL 35476-3835 | |
| (205) 333-1404 | |
| (205) 333-1516 |
| Full Name | Neuropsychology Clinic |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 2804 20th Ave, Northport, Alabama |
| Authorized Official Name and Position | Mark L Prohaska (DIRECTOR) |
| Authorized Official Contact | 2053446169 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Neuropsychology Clinic 2804 20th Ave Northport AL 35476-3835 Ph: (205) 333-1404 | Neuropsychology Clinic 2804 20th Ave Northport AL 35476-3835 Ph: (205) 333-1404 |
| NPI Number | 1093996985 |
|---|---|
| Provider Enumeration Date | 11/19/2007 |
| Last Update Date | 05/05/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093996985 | NPI | - | NPPES |
| 51504930 | Other | AL | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 816 (Alabama) | Primary |
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