MEDICARE: DR. CRAIG MORGAN WOODSMALL 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	2005028855	MO

General Provider Information

NPI Number	:	1477607430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG MORGAN WOODSMALL PSY.D.

Provider Business Mailing Address
First Line	:	1 BROOKINGS DR
Second Line	:	WASHINGTON UNIVERSITY, CAMPUS BOX 1201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-4862
Country	:	US
Telephone Number	:	314-935-5988
Fax Number	:	314-935-8515

Provider Business Practice Location Address
First Line	:	1 BROOKINGS DR
Second Line	:	WASHINGTON UNIVERSITY, CAMPUS BOX 1201
City	:	SAINT LOUIS
State	:	MO
Zip	:	63130-4862
Country	:	US
Telephone Number	:	314-935-5988
Fax Number	:	314-935-8515

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	07/08/2007

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