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NPI Code Detail

MEDICARE: DR. BETH WADDEL PH.D.

MEDICARE: DR. BETH WADDEL PH.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
1103T00000XPsychologistPSY-249ID

General Provider Information

NPI Number : 1881699536
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BETH WADDEL PH.D.
Provider Business Mailing Address
First Line : 302 STATE ROUTE 27
Second Line :
City : PULLMAN
State : WA
Zip : 99164-0001
Country : US
Telephone Number : 509-332-6000
Fax Number :
Provider Business Practice Location Address
First Line : 814 S WASHINGTON ST
Second Line :
City : MOSCOW
State : ID
Zip : 83843-3049
Country : US
Telephone Number : 280-883-4022
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2005
Last Update Date : 07/08/2007

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