Doctor Name: | DR. GEORGE FEDEN |
NPI Number: | 1740295286 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 20040539 |
Business Practice Address: | 615 N Michigan St 5th Floor South South Bend, IN - 466011033 |
Business Phone Number: | 5792761355 |
Business Fax Number: | |
Mailing Address: | 623 Beaver Dr, NAPERVILLE |
State: | IL |
Postal Code: | 605639784 |
Phone Number: | 6305794363 |
Fax Number: | |
NPI Enumeration Date: | 07/31/2006 |
NPI Last Update Date: | 08/24/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 20040539 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
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. |