Healthcare Provider Details

I. General information

NPI: 1275619777
Provider Name (Legal Business Name): DONALD HAROLD WYKOFF EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 SLIPPERY ROCK RD
GROVE CITY PA
16127
US

IV. Provider business mailing address

1049 SLIPPERY ROCK RD
GROVE CITY PA
16127
US

V. Phone/Fax

Practice location:
  • Phone: 724-458-7907
  • Fax: 724-458-7907
Mailing address:
  • Phone: 724-458-7907
  • Fax: 724-458-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS0015976
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: