Provider Demographics
NPI:1053594853
Name:EAST SLOPE NEUROPSYCHOLOGY, INC.
Entity type:Organization
Organization Name:EAST SLOPE NEUROPSYCHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:KUCERA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-966-2961
Mailing Address - Street 1:1015 S 40TH AVE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3806
Mailing Address - Country:US
Mailing Address - Phone:509-966-2961
Mailing Address - Fax:509-966-2318
Practice Address - Street 1:1015 S 40TH AVE
Practice Address - Street 2:SUITE 24
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3868
Practice Address - Country:US
Practice Address - Phone:509-966-2961
Practice Address - Fax:509-966-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 2939302F00000X
WAPY2939302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8802818Medicare PIN