Doctor Name: | TREVOR CHUANGKUO WU |
NPI Number: | 1346652492 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | |
Business Practice Address: | 220 Cherry St Se Grand Rapids, MI - 495034608 |
Business Phone Number: | 6166855050 |
Business Fax Number: | 6166858962 |
Mailing Address: | 1900 44th St Se, KENTWOOD |
State: | MI |
Postal Code: | 495085008 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/23/2014 |
NPI Last Update Date: | 05/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |