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NPI Code Detail

MEDICARE: MR. RICHARD J SOCWELL MS MSED

MEDICARE:  MR. RICHARD J SOCWELL  MS MSED
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
1103T00000XPsychologist00529IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114963OTHERIABCBS

General Provider Information

NPI Number : 1558362590
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD J SOCWELL MS MSED
Provider Business Mailing Address
First Line : 800 1ST ST NW
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52405
Country : US
Telephone Number : 319-396-1066
Fax Number : 319-396-8779
Provider Business Practice Location Address
First Line : 3100 E AVE NW
Second Line : SUITE 101
City : CEDAR RAPIDS
State : IA
Zip : 52405
Country : US
Telephone Number : 319-396-3110
Fax Number : 319-396-8779
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2005
Last Update Date : 11/14/2007

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Directions to “ MR. RICHARD J SOCWELL MS MSED” Practice Location

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