| Doctor Name: | THERESA GANNON |
| NPI Number: | 1548243413 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | PSY16008 |
| Business Practice Address: | 2825 50th St Ucdhs- Mind Institute Sacramento, CA - 958172308 |
| Business Phone Number: | 9167030290 |
| Business Fax Number: | |
| Mailing Address: | 2825 50th St, Ucdhs- Mind Institute SACRAMENTO |
| State: | CA |
| Postal Code: | 958172308 |
| Phone Number: | 9167030290 |
| Fax Number: | |
| NPI Enumeration Date: | 11/23/2005 |
| NPI Last Update Date: | 02/22/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PSY16008 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| 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. |