NPI 1487192076

Icn PLLC

Organisation Clinical Neuropsychologist Boulder, CO

Practice location

Address: 255 Canyon Blvd STE 300-F, Boulder, CO 80302-4979
Phone: (972) 570-8200
Fax: (972) 402-5621
Mailing address: 5455 Lee Hill Dr, Boulder, CO 80302-9305

Authorised official

Name: Bobby Lee Gant
Title: President
Phone: (720) 552-2995

Registered specialties

Clinical Neuropsychologist Primary

Behavioral Health & Social Service Providers Taxonomy 103G00000X Licence 2998 (CO)

Other Clinical Neuropsychologist providers in Colorado →

Registry record

NPI: 1487192076
Entity type: Organization
NPI issued: 3 Feb 2017
Record last updated: 2 Jan 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.