| Wilhelmina S. Koedam Phd P.a. | |
|
134 S Dixie Hwy Ste 104 Hallandale Beach FL 33009-5423 | |
| (954) 895-4248 | |
| (954) 921-5200 |
| Full Name | Wilhelmina S. Koedam Phd P.a. |
|---|---|
| Speciality | Psychologist |
| Location | 134 S Dixie Hwy Ste 104, Hallandale Beach, Florida |
| Authorized Official Name and Position | Wilhelmina S. Koedam (PRESIDENT/LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 9548954248 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilhelmina S. Koedam Phd P.a. 2999 N.e. 191 St. Suite 701 Aventura FL 33180 Ph: (305) 653-0098 | Wilhelmina S. Koedam Phd P.a. 134 S Dixie Hwy Ste 104 Hallandale Beach FL 33009-5423 Ph: (954) 895-4248 |
| NPI Number | 1851698328 |
|---|---|
| Provider Enumeration Date | 02/18/2011 |
| Last Update Date | 03/18/2024 |
| Certification Date | 03/18/2024 |
| Medicare PECOS PAC ID | 4981881133 |
|---|---|
| Medicare Enrollment ID | O20110615000723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851698328 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY0003507 (Florida) | Primary |
| Provider Name | Wilhelmina S Koedam |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023110863 PECOS PAC ID: 9133306384 Enrollment ID: I20110701000010 |
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