Meridian Neuropsychology PLLC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY-202728 Issued in ID

Legal business name

MERIDIAN NEUROPSYCHOLOGY PLLC

Practice address

3061 S Meridian Rd
Ste 100
Meridian, ID 83642-7962

Phone

(208) 895-9852

Fax

(208) 629-1231

NPI assigned

Oct 20, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jason Southwick, PHDNPI 1538412382

Title

Manager

Phone

(208) 895-9852

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Southwick, PH.D.

  • Clinical Neuropsychologist
  • Boise, ID
  • NPI 1538412382
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715990400000",
    "number": "1114321163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3597 E MONARCH SKY LN STE 240",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836461055",
            "telephone_number": "208-391-7274",
            "fax_number": "208-629-1231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3061 S MERIDIAN RD",
            "address_2": "STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836427962",
            "telephone_number": "208-895-9852",
            "fax_number": "208-629-1231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN NEUROPSYCHOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-20",
        "last_updated": "2024-05-18",
        "certification_date": "2024-05-18",
        "status": "A",
        "authorized_official_last_name": "SOUTHWICK",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-895-9852",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "ID",
            "license": "PSY-202728",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "ID",
            "license": "PSY-202728",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meridian Healthcare LLC
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• Meridian Hearing AIDS LLC (Leslie Milliken)
• Meridian Lighthouse Counseling
• Meridian Marriage and Family Therapy, LLC
• Meridian Pediatric Dentistry, PLLC
• Meridian Pediatrics
• Meridian Physical Medicine
• Meridian Psychological Center PC
• Meridian Smiles Dentistry, PC (Meridian Smiles Dentistry and Orthodontics)

• Clinical Neuropsychologist in Meridian, ID
• Providers in Meridian, ID by specialty
• Clinical Neuropsychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.