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General NPI Number Information
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NPI Number | 1134264237
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Entity Type | Individual
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Provider Name | FREDERICK H LINDBERG PHD
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 136 S WASHINGTON ST
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City | CASPER
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State | WY
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Zip | 82601-2739
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Country | US
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Telephone | 307-259-8773
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Fax |
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Provider Business Mailing Address
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Address Line | 5105 CHUCKWAGON TRL
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City | CASPER
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State | WY
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Zip | 82604-9123
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Country | US
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Telephone | 307-237-9093
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 68
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License Number State | WY
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