MEDICARE: DR. RICHARD E WINN JR. PSY.D

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	103TC0700X	Clinical Psychologist	20041472A	IN

General Provider Information

NPI Number	:	1346221934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD E WINN JR. PSY.D

Provider Business Mailing Address
First Line	:	527 N WALNUT ST
Second Line	:
City	:	BRAZIL
State	:	IN
Zip	:	47834-2244
Country	:	US
Telephone Number	:	812-448-9440
Fax Number	:

Provider Business Practice Location Address
First Line	:	527 N WALNUT ST
Second Line	:
City	:	BRAZIL
State	:	IN
Zip	:	47834-2244
Country	:	US
Telephone Number	:	812-448-9440
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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