MEDICARE: TWILA L PRESTON PHD

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	103TC0700X	Clinical Psychologist	531	NE
2	103TC0700X	Clinical Psychologist	2241	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	08406	OTHER	NE	BCBSNE

General Provider Information

NPI Number	:	1841331683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TWILA L PRESTON PHD

Provider Business Mailing Address
First Line	:	8014 STATE LINE RD
Second Line	:	100
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3723
Country	:	US
Telephone Number	:	913-432-2400
Fax Number	:	913-432-2401

Provider Business Practice Location Address
First Line	:	8014 STATE LINE RD
Second Line	:	100
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66208-3723
Country	:	US
Telephone Number	:	913-432-2400
Fax Number	:	913-432-2401

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	06/24/2015

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Directions to “ TWILA L PRESTON PHD” Practice Location

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