MEDICARE: DALLAS WINROD ED.S, NCSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist	OH3028746	OH

General Provider Information

NPI Number	:	1205259934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLAS WINROD ED.S, NCSP

Provider Business Mailing Address
First Line	:	50 DELAWARE DR
Second Line	:
City	:	GNADENHUTTEN
State	:	OH
Zip	:	44629-9706
Country	:	US
Telephone Number	:	740-561-4021
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 DELAWARE DR
Second Line	:
City	:	GNADENHUTTEN
State	:	OH
Zip	:	44629-9706
Country	:	US
Telephone Number	:	740-561-4021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2014
Last Update Date	:	01/31/2014

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