Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | PY 01441 | MO |
Y | 103G00000X | Clinical Psychologist | PY 01441 | MO |
Y | 103TC0700X | Clinical Psychologist | PY 01441 | MO |
N | 103TR0400X | Rehabilitation Psychologist | PY 01441 | MO |
NPI | 1154384923 |
---|---|
Provider Name | Ruth Davies Sulser |
First Address | Saint Louis, MO 63125-4181 |
Second Address | Saint Louis, MO 63125-4181 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 10/07/2007 |