MEDICARE: CEDRIC NEAL SIMPSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TM1800X	Intellectual & Developmental Disabilities Psychologist

General Provider Information

NPI Number	:	1144983610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CEDRIC NEAL SIMPSON

Provider Business Mailing Address
First Line	:	711 LODGE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43609-2915
Country	:	US
Telephone Number	:	313-492-4679
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 LODGE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43609-2915
Country	:	US
Telephone Number	:	313-492-4679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2021
Last Update Date	:	10/20/2021

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Directions to “ CEDRIC NEAL SIMPSON ” Practice Location

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