Healthcare Provider Details

I. General information

NPI: 1568406361
Provider Name (Legal Business Name): LINDA RAE FELDTHAUSEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

6251 SW 85TH ST
GAINESVILLE FL
32608-8512
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax: 352-379-4026
Mailing address:
  • Phone: 352-367-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY6952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: