GREAT LAKES INSTITUTE FOR NEUROPSYCHOLOGY & BEHAVIORAL HEALTH (NPI# 1750599981) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750599981 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES INSTITUTE FOR NEUROPSYCHOLOGY & BEHAVIORAL HEALTH |
| Practice Address |
494 S Emerson Ave Suite C Greenwood IN 46143-1912 |
| Practice Telephone | 3178893901 |
| Practice Fax Number | 3178893902 |
| Mailing Telephone | 3178893901 |
| Mailing Fax Number | 3178893902 |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2020-03-19 |
| Authorized Official Name | DR. SANFORD LLOYD PEDERSON (PRESIDENT) |
| Authorized Official Telephone | 3178893901 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0700X |
Psychologist Specialization: Adult Development & Aging |
Behavioral Health & Social Service Providers | ||
| N | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
Behavioral Health & Social Service Providers | ||
| N | 103TF0200X |
Psychologist Specialization: Forensic |
Behavioral Health & Social Service Providers | ||
| N | 103TH0004X |
Psychologist Specialization: Health |
Behavioral Health & Social Service Providers | ||
| N | 103TH0100X |
Psychologist Specialization: Health Service |
Behavioral Health & Social Service Providers | ||
| N | 103TR0400X |
Psychologist Specialization: Rehabilitation |
Behavioral Health & Social Service Providers | ||
| Y | 103G00000X | Clinical Neuropsychologist | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200227370 | 05 |
| Street Address |
494 S EMERSON AVE SUITE C |
| City | GREENWOOD |
| State | IN |
| Zip Code | 46143-1912 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073502498 | Constance J Tooley | Counselor | 494 S Emerson Ave, Suite B, Greenwood, IN 46143-1912 | 2005-10-18 |
| 1114319522 | Diane M. Stone | Counselor | 494 S Emerson Ave, Suite B, Greenwood, IN 46143-1912 | 2015-02-21 |
| 1093145955 | Renee Heldman | Counselor | 494 S Emerson Ave, B, Greenwood, IN 46143-1912 | 2013-11-13 |
| 1841629995 | Barrow and Associates | Psychologist | 494 S Emerson Ave, Suite B, Greenwood, IN 46143-1912 | 2013-11-08 |
| 1841541711 | The Bachman Group, P.C. | Dentist | 494 S Emerson Ave, Suite K, Greenwood, IN 46143-1912 | 2012-10-02 |
| 1013212729 | Senior Helpers | In Home Supportive Care | 494 S Emerson Ave, Suite I-2, Greenwood, IN 46143-1912 | 2011-01-12 |
| 1588893358 | Jenny Ilisha Munden | Dentist | 494 S Emerson Ave, Suite K, Greenwood, IN 46143-1912 | 2009-07-14 |
| 1154512101 | Cara Aileen Misetic | Psychologist | 494 S Emerson Ave, Suite D, Greenwood, IN 46143-1912 | 2007-08-06 |
| 1659589885 | Sanford Lloyd Pederson | Clinical Neuropsychologist | 494 S Emerson Ave, Suite C, Greenwood, IN 46143-1912 | 2007-05-20 |
| 1114003597 | Jerry Robert Davis | Dentist | 494 S Emerson Ave, Suite K, Greenwood, IN 46143-1912 | 2006-10-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395299 | Tiffany Smirat | Pharmacist | 882 S Sr 135, Greenwood, IN 46143 | 2020-10-27 |
| 1083250138 | Benajmin Thomas Nyboer | Pharmacist | 5961 North State Road 135, Kroger Pharmacy, Greenwood, IN 46143 | 2019-11-25 |
| 1609417260 | Orthopaedics-indianapolis, Inc | Orthopaedic Surgery | 1579 Olive Branch Parke Lane, Suite 130, Greenwood, IN 46143 | 2019-10-04 |
| 1194282525 | Homebased Mental Health Service | Case Management | 2244 Blossom Dr, Greenwood, IN 46143 | 2019-02-21 |
| 1710478078 | Anne E Packard | Pharmacist | 333 E County Line Rd # 101, Greenwood, IN 46143 | 2018-05-22 |
| 1033607924 | Ez Clinic Inc. | Nurse Practitioner | 494 S Emerson Ave Ste I, Greenwood, IN 46143 | 2018-04-25 |
| 1891246633 | Kroger Limited Partnership I | Durable Medical Equipment & Medical Supplies | 5961 N Sr 135, Greenwood, IN 46143 | 2016-10-17 |
| 1477919637 | Ourhealth Physicians Group, LLC | Clinic/Center | 1273 N Emerson Ave Ste H, Greenwood, IN 46143 | 2016-01-04 |
| 1003212655 | American Health Network of Indiana, LLC | Non-Pharmacy Dispensing Site | 2355 Endress Place St A, Healthy Measures Wellness Clinic, Greenwood, IN 46143 | 2014-11-10 |
| 1265831366 | Katie D'agosto | Counselor | 3000 S State Road 135 Ste 230, Greenwood, IN 46143 | 2014-08-14 |
| Find all providers in zip 46143 | ||||
| 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 |
|---|---|---|---|---|
| 1659589885 | Sanford Lloyd Pederson | Clinical Neuropsychologist | 494 S Emerson Ave, Suite C, Greenwood, IN 46143-1912 | 2007-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386203537 | Michael John Wilson | Clinical Neuropsychologist | 9301 Madison St Rm 369, Crown Point, IN 46307-7745 | 2019-06-11 |
| 1497273015 | Jana Beth Dykstra | Clinical Neuropsychologist | 355 W 16th Street Goodman Hall, Indianapolis, IN 46202 | 2017-09-04 |
| 1558779355 | Neurobehavioral Consultants, LLC | Clinical Neuropsychologist | 4356 N College Ave, Indianapolis, IN 46205-1932 | 2014-07-24 |
| 1275973257 | Courtney Beth Johnson | Clinical Neuropsychologist | 2680 E Main St Ste 114, Plainfield, IN 46168-2827 | 2013-07-05 |
| 1619275807 | Renee Elizabeth Buskirk | Clinical Neuropsychologist | 11143 Parkview Plaza Dr Ste 207, Fort Wayne, IN 46845-1728 | 2011-03-11 |
| 1417251109 | Bradford J Eaton Phd | Clinical Neuropsychologist | 15744 Sunrise Trl, Granger, IN 46530-9034 | 2011-01-10 |
| 1306170626 | Elizabeth Begyn | Clinical Neuropsychologist | 541 Clinical Dr # Cl285, Indianapolis, IN 46202-5233 | 2009-09-21 |
| 1285865378 | Anps-in LLC | Clinical Neuropsychologist | 908 Roosevelt Rd, Suite K, Valparaiso, IN 46383-4375 | 2009-08-06 |
| 1215101696 | Michelle Anne Keiski | Clinical Neuropsychologist | 355 W 16th St Ste 4700, Indianapolis, IN 46202-2285 | 2008-04-17 |
| 1669641114 | Estes Neuropsychology, LLC | Clinical Neuropsychologist | 1655 N Gladstone Ave Ste D, Columbus, IN 47201-5380 | 2008-02-28 |
| Find all providers with the same taxonomy | ||||
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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.