MEDICARE: FREDERICK H LINDBERG PHD

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	68	WY

General Provider Information

NPI Number	:	1134264237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK H LINDBERG PHD

Provider Business Mailing Address
First Line	:	5105 CHUCKWAGON TRL
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82604-9123
Country	:	US
Telephone Number	:	307-237-9093
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 S WASHINGTON ST
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-2739
Country	:	US
Telephone Number	:	307-259-8773
Fax Number	:

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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