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NPI Code Detail

MEDICARE: MS. SUSAN SINDEL VILLASANA PSYCHOLOGIST

MEDICARE: MS. SUSAN SINDEL VILLASANA PSYCHOLOGIST
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
1103T00000XPsychologistPY01398MO

General Provider Information

NPI Number : 1245369123
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN SINDEL VILLASANA PSYCHOLOGIST
Provider Business Mailing Address
First Line : 8 RIDGEMOOR DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63105-3038
Country : US
Telephone Number : 314-862-2567
Fax Number :
Provider Business Practice Location Address
First Line : 8 RIDGEMOOR DR
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63105-3038
Country : US
Telephone Number : 314-862-2567
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/09/2007

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