=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417936592
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES W SIDDALL PHD AND ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2006
-----------------------------------------------------
Last Update Date | 10/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4057 CLEVELAND MASSILLON RD
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44203-5638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-825-5734
-----------------------------------------------------
Fax | 330-825-5151
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4057 CLEVELAND MASSILLON RD
-----------------------------------------------------
City | NORTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44203-5638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-825-5734
-----------------------------------------------------
Fax | 330-825-5151
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PSYCHOLOGIST
-----------------------------------------------------
Name | DR. JAMES WARNER SIDDALL
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 330-825-5734
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 2002
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------