Healthcare Provider Details

I. General information

NPI: 1831357938
Provider Name (Legal Business Name): JOSALYN ICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 NATIONAL RD
WHEELING WV
26003-5370
US

IV. Provider business mailing address

2606 NATIONAL RD
WHEELING WV
26003-5370
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-7060
  • Fax: 304-242-7076
Mailing address:
  • Phone: 304-242-7060
  • Fax: 304-242-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number935
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: