Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | MO1 | MO |
N | 103TC0700X | Clinical Psychologist | MO1 | MO |
Y | 175F00000X | Naturopath | ||
N | 175L00000X | Homeopath | ||
N | 175M00000X | Lay Midwife |
NPI | 1790982106 |
---|---|
Provider Name | Kevin W Louderback |
First Address | Mount Vernon, MO 65712-1735 |
Second Address | Mount Vernon, MO 65712-1735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 25/06/2014 |