Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 21009 | WV |
NPI | 1003004854 |
---|---|
Provider Name | Edward Lee Winter |
First Address | Beckley, WV 25801-3212 |
Second Address | Fayetteville, WV 25840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2007 |
Last Update Date | 05/10/2007 |