David E. Nilsson, PH.D., P.C.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY-230 Issued in ID

Legal business name

DAVID E. NILSSON, PH.D., P.C.

Doing business as

The NeuroDevelopment Resource Center

Practice address

950 W Bannock St Ste 1100
Boise, ID 83702-6140

Phone

(208) 947-5368

Fax

(888) 328-9210

NPI assigned

Apr 28, 2012

Last updated

Apr 28, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Cindy Nilsson, PT

Title

Clinic Director

Phone

(208) 947-5368

Specialties & licenses 1

Addresses

Other names 1

• The NeuroDevelopment Resource Center Doing business as

Locations

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

{
    "created_epoch": "1335571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335571200000",
    "number": "1275891194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 W BANNOCK ST STE 1100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026140",
            "telephone_number": "208-947-5368",
            "fax_number": "888-328-9210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 W BANNOCK ST STE 1100",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026140",
            "telephone_number": "208-947-5368",
            "fax_number": "888-328-9210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID E. NILSSON, PH.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-28",
        "last_updated": "2012-04-28",
        "status": "A",
        "authorized_official_last_name": "NILSSON",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "208-947-5368",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "ID",
            "license": "PSY-230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The NeuroDevelopment Resource Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.