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Individual

DR. DANIEL TOD WOLVERTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
6520 GLENRIDGE PARK PL, STE 3, LOUISVILLE, KY 40222-3453
(502) 893-8822
Mailing address
6520 GLENRIDGE PARK PL, STE 3, LOUISVILLE, KY 40222-3453
(502) 893-8822

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0942
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P300041276
MEDICARE PTAN
KY
Enumeration date
03/03/2007
Last updated
09/12/2014
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