MEDICARE: DR. STEPHEN ANTHONY PARKER PSYD LP

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	103T00000X	Psychologist	LP2149	MN

General Provider Information

NPI Number	:	1598731366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ANTHONY PARKER PSYD LP

Provider Business Mailing Address
First Line	:	2324 UNIVERSITY AVE W
Second Line	:	SUITE 100
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1843
Country	:	US
Telephone Number	:	612-343-1625
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 UNIVERSITY AVE W
Second Line	:	SUITE 100
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1843
Country	:	US
Telephone Number	:	612-343-1625
Fax Number	:

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	07/08/2007

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