David Lee Wickstrom in Blythewood - Clinical
David Lee Wickstrom - NPI 1366594202
David Lee Wickstrom is a Clinical in Blythewood, South Carolina. David Lee Wickstrom practices all healthcare services and medical treatments related to Clinical. The NPI Number for David Lee Wickstrom is 1366594202. The last update date is 2007-07-08.
David Lee Wickstrom's current location address is 420 Longtown Rd W, Blythewood, South Carolina. You can contact this provider via phone number 8033182009 and fax number 8036919298. The mailing address for David Lee Wickstrom is 420 Longtown Rd W, Blythewood, South Carolina. To know further, please read the information below!
Provider Profile Detail
| Provider Name | David Lee Wickstrom |
|---|---|
| Address | 420 Longtown Rd W, Blythewood, South Carolina |
| Phone Number | 8033182009 |
| Fax Number | 8036919298 |
| Sole Proprietor | Y |
| Credentials | PSYCHOLOGI |
NPI Number Detail
| NPI Number | 1366594202 |
|---|---|
| Provider Enumeration Date | 2007-01-18 |
| Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
| Address | 420 Longtown Rd W |
|---|---|
| City | Blythewood |
| State | South Carolina (SC) |
| Post Code | 290169450 |
| Phone Number | 8033182009 |
| Fax Number | 8036919298 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 103Tc0700X |
| Licence No | 591 |
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Definition: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in |
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What is the unique 10-digit identification code issued to David Lee Wickstrom by the Centers for Medicare & Medicaid Services?
The David Lee Wickstrom has been assigned the NPI (National Provider Identifier) 1366594202 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Could you share the physical location details of David Lee Wickstrom?
The David Lee Wickstrom is situated at 420 Longtown Rd W, in the city of Blythewood, state of SC, with the zip code 290169450.
What is David Lee Wickstrom's specialized field of practice, and what is the corresponding taxonomy classification code?
The David Lee Wickstrom's area of specialization is Clinical, and the corresponding taxonomy code that categorizes this field of practice is 103Tc0700X.
On what date was the 1366594202 assigned to David Lee Wickstrom?
The David Lee Wickstrom was issued its 1366594202 on 2007-01-18, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
When was the David Lee Wickstrom's information last updated?
The David Lee Wickstrom's information was last updated on 2007-07-08.
NPI Number: 1982607784
Address: 54045 Ridge Rd, Yucca Valley, CA