Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 01340 | MO |
Y | 103T00000X | Psychologist | 01340 | MO |
NPI | 1003853367 |
---|---|
Provider Name | Linda Schultz |
First Address | Jefferson City, MO 65109 |
Second Address | Jefferson City, MO 65109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 01/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
109947 | BCBS (01) | MO |
493345003 | (05) | MO |