Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 20040361A | IN |
Y | 103TC0700X | Clinical Psychologist | 20040361A | IN |
N | 103G00000X | Clinical Psychologist | 6301011586 | MI |
N | 103TC0700X | Clinical Psychologist | 6301011586 | MI |
NPI | 1003983115 |
---|---|
Provider Name | Dr. Linda Monroe |
First Address | Mishawaka, IN 46545-3015 |
Second Address | Mishawaka, IN 46545-3015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 13/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100091350C | (05) | IN |
351877953 | TRICARE PROVIDER NUMBER (01) | IN |
R33364 | (02) | IN |