MEDICARE: VICKI SUE BRANSTETTER PLPC

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	101YP2500X	Professional Counselor	2018039118	MO

General Provider Information

NPI Number	:	1407328503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI SUE BRANSTETTER PLPC

Provider Business Mailing Address
First Line	:	600 SARGENT LN
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-7526
Country	:	US
Telephone Number	:	573-783-4400
Fax Number	:	573-783-4409

Provider Business Practice Location Address
First Line	:	600 SARGENT LN
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-7526
Country	:	US
Telephone Number	:	573-783-4400
Fax Number	:	573-783-4409

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

Provider Enumeration Date	:	12/30/2018
Last Update Date	:	12/30/2018

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