THERESA GANNON PH.D. NPI 1548243413

NPI Information

NPI: 1548243413
Provider Name: THERESA GANNON, PH.D.
Classification: Clinical Neuropsychologist - 103G00000X
Entity Type: Individual
Address:
2825 50TH ST
UCDHS- MIND INSTITUTE
SACRAMENTO, CA
ZIP 95817
Phone: (916) 703-0290
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Theresa Gannon, PH.D. is a clinical neuropsychologist in Sacramento, CA. The provider is a clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems. Theresa Gannon, PH.D. NPI is 1548243413. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2825 50TH ST
UCDHS- MIND INSTITUTE
SACRAMENTO, CA
ZIP 95817-308
Phone: (916) 703-0290

The enumeration date for this NPI number is 11/23/2005 and was last updated on 2/22/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103G00000X	Clinical Neuropsychologist		PSY16008	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	GR002104M	OTHER	CALIFORNIA	MEDI-CAL GROUP NUMBER
2	06999B	MEDICARE UPIN	CALIFORNIA
3	PSY16008	OTHER	CALIFORNIA	PSYCHOLOGIST LICENSE #

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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