Healthcare Provider Details

I. General information

NPI: 1427492552
Provider Name (Legal Business Name): ANNA BUCKINGHAM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2013
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 ELM ST
MISSOURI VALLEY IA
51555-1140
US

IV. Provider business mailing address

7261 MERCY RD
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 712-642-2794
  • Fax: 712-642-2794
Mailing address:
  • Phone: 402-398-6248
  • Fax: 712-642-9338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number113265
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: