MEDICARE: POLLOCK PSYCHOLOGICAL SERVICES LLC

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	2005028345	MO

General Provider Information

NPI Number	:	1851539241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLLOCK PSYCHOLOGICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1030 WESTWOOD DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-1855
Country	:	US
Telephone Number	:	573-635-3842
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 WESTWOOD DR
Second Line	:
City	:	JEFFERSON CTY
State	:	MO
Zip	:	65109-1855
Country	:	US
Telephone Number	:	573-680-6910
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. ANN MARGARET POLLOCK
Credential	:	PSYD
Telephone Number	:	573-680-6910

Provider Enumeration Date	:	01/23/2009
Last Update Date	:	03/13/2009

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