Provider Demographics
NPI:1740639897
Name:GAMEZ, WAKIZA (PHD)
Entity type:Individual
Prefix:
First Name:WAKIZA
Middle Name:
Last Name:GAMEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1670
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-1670
Mailing Address - Country:US
Mailing Address - Phone:319-333-8963
Mailing Address - Fax:
Practice Address - Street 1:1703 ROCHESTER CT
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-3241
Practice Address - Country:US
Practice Address - Phone:319-333-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001143103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical