Provider Demographics
NPI:1205882313
Name:NEUROPSYCHOLOGICAL SERVICES PC
Entity type:Organization
Organization Name:NEUROPSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:WILBURN
Authorized Official - Last Name:BYLSMA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-738-4528
Mailing Address - Street 1:3375 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7701
Mailing Address - Country:US
Mailing Address - Phone:847-394-4174
Mailing Address - Fax:847-394-4176
Practice Address - Street 1:3375 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE K
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7701
Practice Address - Country:US
Practice Address - Phone:847-394-4174
Practice Address - Fax:847-394-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213761Medicare ID - Type UnspecifiedCOOK COUNTY
IL213762Medicare ID - Type UnspecifiedOTHER IL COUNTIES