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NPI Code Detail

MEDICARE: DR. JANINE B. BRODEUR PHD

MEDICARE: DR. JANINE B. BRODEUR 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
1163W00000XRegistered Nurse065986MO
2103TC0700XClinical Psychologist1999140465MO

General Provider Information

NPI Number : 1396867073
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JANINE B. BRODEUR PHD
Provider Business Mailing Address
First Line : 417 MISSION COURT
Second Line :
City : ST LOUIS
State : MO
Zip : 63130-4018
Country : US
Telephone Number : 314-726-3487
Fax Number :
Provider Business Practice Location Address
First Line : 7396 PERSHING AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63130-4206
Country : US
Telephone Number : 314-333-9474
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 06/18/2019

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