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General NPI Number Information
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NPI Number | 1497079156
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Entity Type | Organization
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Legal Business Name | WINSLOW CLINIC PLLC
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 09/14/2010
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Provider Practice Location Address
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Address Line | 411 10TH ST SE SUITE 150
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City | CEDAR RAPIDS
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State | IA
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Zip | 52403-2442
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Country | US
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Telephone | 319-491-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 3520 SWALLOW CT NE
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City | CEDAR RAPIDS
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State | IA
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Zip | 52402-2664
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Country | US
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Telephone | 319-491-6868
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Fax | 319-265-3948
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE WINSLOW JASPER
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Credential | PH.D.
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Telephone | 319-491-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 001037
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License Number State | IA
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