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Individual

MR. FREDERICK WALLACE NOLEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
31890 COLD SPRING AVE, WARSAW, MO 65355-4877
(913) 907-5997
Mailing address
7995 E CO RD 350 N, CAMPBELLSBURG, IN 47108
(913) 907-5997

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
000776
MO
103T00000X
Psychologist
20042593A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
493458632
MO
Enumeration date
10/24/2006
Last updated
11/08/2021
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