Provider Demographics
NPI:1417848763
Name:WESTSIDE NEUROPSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:WESTSIDE NEUROPSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NEUROPSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, ABPP-CN
Authorized Official - Phone:616-287-4164
Mailing Address - Street 1:5030 CORPORATE EXCHANGE BLVD SE STE 201
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-5506
Mailing Address - Country:US
Mailing Address - Phone:616-287-4164
Mailing Address - Fax:
Practice Address - Street 1:5030 CORPORATE EXCHANGE BLVD SE STE 201
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-5506
Practice Address - Country:US
Practice Address - Phone:616-287-4164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty