AXISCARE NEUROPSYCHOLOGY, LLC (NPI# 1669812756) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669812756 |
| Entity Type | Organization |
| Organization Name | AXISCARE NEUROPSYCHOLOGY, LLC |
| Practice Address |
2580 Foxfield Rd Ste 101-4 St Charles IL 60174-1403 |
| Mailing Address |
Po Box 2257 Chesterton IN 46304-0357 |
| Practice Telephone | 8472848133 |
| Mailing Telephone | 2199268320 |
| Mailing Fax Number | 2199263524 |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2016-06-12 |
| Authorized Official Name | NEAL R BOWEN (OWNER) |
| Authorized Official Telephone | 8472848133 |
| Authorized Official Credential | PSYD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | Behavioral Health & Social Service Providers |
| Street Address |
2580 FOXFIELD RD STE 101-4 |
| City | ST CHARLES |
| State | IL |
| Zip Code | 60174-1403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104292820 | Nina Appadurai | Clinical Neuropsychologist | 2580 Foxfield Rd Ste 101-4, St Charles, IL 60174-1403 | 2015-08-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306474192 | Halinas Residential Home Care | Registered Nurse | 825 North Fifth Avenue, St. Charles, IL 60174 | 2020-03-29 |
| 1205354503 | Connor Lavallie | Chiropractor | 240 W River Dr, St Charles, IL 60174 | 2017-09-07 |
| 1427579952 | Melanie Elizabeth Long | Counselor | 5n147 Oak Leaf Ct, St Charles, IL 60174 | 2017-07-06 |
| 1255860656 | Hannah Elizabeth Gambrel | Counselor | 12 South 7th Avenue, St. Charles, IL 60174 | 2017-06-08 |
| 1275981490 | Anju Patel | Pharmacist | 2038 Praire St, St. Charles, IL 60174 | 2016-05-27 |
| 1316328529 | Allison Jensen | Dentist | 11 S. 2nd Ave #11, St. Charles, IL 60174 | 2015-06-12 |
| 1225466576 | Chelsea Wright | Social Worker | 522 W Main St Unit 2d, St Charles, IL 60174 | 2013-10-24 |
| 1114261427 | Bryan R. Cichon Dds PC | Dentist | 700 S. Randall Rd., Suite #1, St. Charles, IL 60174 | 2012-11-27 |
| 1124372289 | Stacey Lynn Conner | Developmental Therapist | 910 Manley Rd, St. Charles, IL 60174 | 2012-10-28 |
| 1093070567 | St. Charles Service Corporation | Physical Therapist | 1615 W. Main Street, St. Charles, IL 60174 | 2012-07-10 |
| Find all providers in zip 60174 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689808750 | Lance David Reinke | Clinical Neuropsychologist | 2445 Dean St Ste 1a, St Charles, IL 60175-4828 | 2009-05-05 |
| 1114040227 | Susan Christine Valessares | Clinical Neuropsychologist | 3 Squire Ln, St Charles, IL 60174-1413 | 2007-04-06 |
| 1063585933 | Neal Ross Bowen | Clinical Neuropsychologist | 2580 Foxfield Rd, Ste 101-4, St Charles, IL 60174-1403 | 2006-11-16 |
| 1104292820 | Nina Appadurai | Clinical Neuropsychologist | 2580 Foxfield Rd Ste 101-4, St Charles, IL 60174-1403 | 2015-08-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477183556 | Michelle Yvonne Kibby-faglier | Clinical Neuropsychologist | 285 Lake Indian Hills Dr, Carbondale, IL 62902-6184 | 2020-01-17 |
| 1003456708 | David Jackson | Clinical Neuropsychologist | 6 Parkway North Blvd, Deerfield, IL 60015-2522 | 2020-01-10 |
| 1649830159 | Natalie Berger | Clinical Neuropsychologist | 1645 W Jackson Blvd Ste 203, Chicago, IL 60612-3227 | 2019-06-17 |
| 1043877475 | Sarah Mailander Dyer | Clinical Neuropsychologist | 900 Royal Heights Rd Ste 14, Belleville, IL 62226-5457 | 2019-05-21 |
| 1639655632 | Julia Digangi | Clinical Neuropsychologist | 920 N York Rd, Hinsdale, IL 60521-2996 | 2018-07-13 |
| 1891211710 | Kenneth Vicencio | Clinical Neuropsychologist | 4100 Healthway Drive, Aurora, IL 60504 | 2017-08-22 |
| 1538690466 | Kathleen Ares | Clinical Neuropsychologist | 4440 W 95th, Suite 1200h, Oak Lawn, IL 60453 | 2017-03-22 |
| 1225575871 | Israel Gross | Clinical Neuropsychologist | 1934 W. Roscoe St., #4, Chicago, IL 60657 | 2017-01-20 |
| 1013462829 | Ann Westcot Jordan | Clinical Neuropsychologist | 21037 Benjamin Dr, Shorewood, IL 60404-0612 | 2016-08-22 |
| 1740638915 | Elizabeth Regina Tuminello Hartman | Clinical Neuropsychologist | 1875 Dempster St Ste 520, Park Ridge, IL 60068-1130 | 2016-05-29 |
| Find all providers with the same taxonomy | ||||
| City | ST CHARLES |
| Zip Code | 60174 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.