Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 622 | IA |
N | 103T00000X | Psychologist | 622 | IA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 00622 | IA |
N | 103TH0004X | Health Psychologist | 00210 | IA |
N | 103TS0200X | School Psychologist | 00622 | IA |
NPI | 1437220365 |
---|---|
Provider Name | Dr. Kevin Michael Wood |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 29/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0459529 | (05) | IA |
31342 | UNKNOWN (01) | IA |
P77769 | (02) | IA |