MEDICARE: MS. LINDA LEE RICHARDSON L.C.S.W

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	1041C0700X	Clinical Social Worker	SW004585	MO

General Provider Information

NPI Number	:	1689664450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA LEE RICHARDSON L.C.S.W

Provider Business Mailing Address
First Line	:	9391 TILLES DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-1013
Country	:	US
Telephone Number	:	314-968-8585
Fax Number	:	314-968-3655

Provider Business Practice Location Address
First Line	:	1000 LAKE SAINT LOUIS BLVD
Second Line	:	SUITE 217
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-1340
Country	:	US
Telephone Number	:	314-968-8585
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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