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
1	103T00000X	Psychologist	00529	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14963	OTHER	IA	BCBS

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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