Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY 9025 | CA |
N | 103T00000X | Psychologist | PSY 9025 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY 9025 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 9025 | CA |
NPI | 1134147416 |
---|---|
Provider Name | Dr. John R Winslow Ii |
First Address | Lakeport, CA 95453-5202 |
Second Address | Lakeport, CA 95453-5202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |