Gannon, Theresa

Gannon, Theresa is an individual health care provider with primary practice located at 2825 50Th St Ucdhs- Mind Institute, Sacramento CA 95817-2308. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Neuropsychologist, which is considered as her primary health care specialty. Gannon, Theresa can be contacted via phone (916) 703-0290.

Contact Information

Primary practice address
2825 50Th St Ucdhs- Mind Institute Sacramento CA 95817-2308
Phone: (916) 703-0290
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Neuropsychologist 103G00000X PSY16008 California

Profile Details

NPI number 1548243413
LBN Legal business name Gannon, Theresa
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 23rd, 2005
Last updated Feb 22nd, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548243413 NPPES
California Other PSY16008 PSYCHOLOGIST LICENSE #
California Other GR002104M PSYCHOLOGIST LICENSE #

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