MEDICARE: DR. LINDA M FREY 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	381	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52671	OTHER	MT	BLUECROSS BLUESHIELD - MT

General Provider Information

NPI Number	:	1073551818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA M FREY PH.D.

Provider Business Mailing Address
First Line	:	121 HICKORY ST
Second Line	:	STE 1
City	:	MISSOULA
State	:	MT
Zip	:	59801-1896
Country	:	US
Telephone Number	:	406-830-3116
Fax Number	:	406-830-3105

Provider Business Practice Location Address
First Line	:	121 HICKORY ST
Second Line	:	STE 1
City	:	MISSOULA
State	:	MT
Zip	:	59801-1896
Country	:	US
Telephone Number	:	406-830-3116
Fax Number	:	406-830-3105

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	02/22/2012

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