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General NPI Number Information
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NPI Number | 1295747079
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Entity Type | Individual
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Provider Name | JOHN E. THVEDT EDD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4715 VIEWRIDGE AVE STE 230
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City | SAN DIEGO
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State | CA
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Zip | 92123-1680
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Country | US
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Telephone | 800-257-8715
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Fax |
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Provider Business Mailing Address
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Address Line | 55 N CHURCH ST APT 1
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City | EPHRATA
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State | PA
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Zip | 17522-2080
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Country | US
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Telephone | 717-721-3890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS 008371L
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License Number State | PA
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