Healthcare Provider Details

I. General information

NPI: 1609959162
Provider Name (Legal Business Name): CLAUDIA R BODWAY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CAISSON HILL ROAD ATTN: MCXX-CLD-QM (CREDENTIALS)
FORT RILEY KS
66442-5037
US

IV. Provider business mailing address

600 CAISSON HILL ROAD ATTN: MCXX-CLD-QM (CREDENTIALS)
FORT RILEY KS
66442-5037
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7208
  • Fax: 785-239-7364
Mailing address:
  • Phone: 785-239-7208
  • Fax: 785-239-7364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number800
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: