Provider Demographics
NPI:1902456569
Name:NEUROPSYCHOLOGICAL SERVICES OF SOUTHEASTERN WISCONSIN,LTD
Entity Type:Organization
Organization Name:NEUROPSYCHOLOGICAL SERVICES OF SOUTHEASTERN WISCONSIN,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-751-4499
Mailing Address - Street 1:1132 S WATERVILLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-8401
Mailing Address - Country:US
Mailing Address - Phone:262-751-4499
Mailing Address - Fax:262-303-4161
Practice Address - Street 1:200 S EXECUTIVE DR STE 101
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4216
Practice Address - Country:US
Practice Address - Phone:262-780-1592
Practice Address - Fax:262-303-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty