Provider Demographics
NPI:1497079156
Name:WINSLOW CLINIC PLLC
Entity Type:Organization
Organization Name:WINSLOW CLINIC PLLC
Other - Org Name:THE WINSLOW CLINIC, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:WINSLOW
Authorized Official - Last Name:JASPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:319-491-6868
Mailing Address - Street 1:3520 SWALLOW CT NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2664
Mailing Address - Country:US
Mailing Address - Phone:319-491-6868
Mailing Address - Fax:319-265-3948
Practice Address - Street 1:411 10TH ST SE
Practice Address - Street 2:SUITE 150
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2442
Practice Address - Country:US
Practice Address - Phone:319-491-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001037103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty