Healthcare Provider Details

I. General information

NPI: 1417936592
Provider Name (Legal Business Name): JAMES W SIDDALL PHD AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4057 CLEVELAND MASSILLON RD
NORTON OH
44203-5638
US

IV. Provider business mailing address

4057 CLEVELAND MASSILLON RD
NORTON OH
44203-5638
US

V. Phone/Fax

Practice location:
  • Phone: 330-825-5734
  • Fax: 330-825-5151
Mailing address:
  • Phone: 330-825-5734
  • Fax: 330-825-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2002
License Number StateOH

VIII. Authorized Official

Name: DR. JAMES WARNER SIDDALL
Title or Position: OWNER/PSYCHOLOGIST
Credential: PHD
Phone: 330-825-5734