Provider Demographics
NPI:1932278439
Name:WALLJASPER MCWILLIAMS, CYNTHIA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:MARIE
Last Name:WALLJASPER MCWILLIAMS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:MARIE
Other - Last Name:WALLJASPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1501 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-3002
Mailing Address - Country:US
Mailing Address - Phone:319-385-1919
Mailing Address - Fax:319-385-9026
Practice Address - Street 1:1501 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-3002
Practice Address - Country:US
Practice Address - Phone:319-385-1919
Practice Address - Fax:319-385-9026
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0739961Medicaid
IA0739961Medicaid
IAP46592Medicare UPIN