MEDICARE: DR. LINDA MARIE HOUSMAN PH.D.

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	PY01883	MO

General Provider Information

NPI Number	:	1043435290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA MARIE HOUSMAN PH.D.

Provider Business Mailing Address
First Line	:	4515 MARYLAND AVE
Second Line	:	609
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1952
Country	:	US
Telephone Number	:	314-454-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 OLIVE ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63103-1337
Country	:	US
Telephone Number	:	314-531-5355
Fax Number	:

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

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	07/08/2007

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