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NPI Code Detail

MEDICARE: MS. LINDA ANN THIBODEAU L.P.

MEDICARE: MS. LINDA ANN THIBODEAU L.P.
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
1103T00000XPsychologist5227MN

General Provider Information

NPI Number : 1083828800
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LINDA ANN THIBODEAU L.P.
Provider Business Mailing Address
First Line : 1610 21ST AVE NE
Second Line :
City : ROCHESTER
State : MN
Zip : 55906-4397
Country : US
Telephone Number : 507-281-1265
Fax Number :
Provider Business Practice Location Address
First Line : 343 WOODLAKE DR SE
Second Line :
City : ROCHESTER
State : MN
Zip : 55904-6242
Country : US
Telephone Number : 507-287-7105
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2007
Last Update Date : 12/30/2010

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Directions to “ MS. LINDA ANN THIBODEAU L.P.” Practice Location

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