MEDICARE: MS. KIMBERLY A SLOAN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	01486	MO

General Provider Information

NPI Number	:	1336162536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY A SLOAN PHD

Provider Business Mailing Address
First Line	:	600 MEDICAL DR
Second Line	:	STE 205
City	:	WENTZVILLE
State	:	MO
Zip	:	63385
Country	:	US
Telephone Number	:	636-332-5050
Fax Number	:	636-327-4723

Provider Business Practice Location Address
First Line	:	600 MEDICAL DR
Second Line	:	STE 205
City	:	WENTZVILLE
State	:	MO
Zip	:	63385
Country	:	US
Telephone Number	:	636-332-5050
Fax Number	:	636-327-4723

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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