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NPI Code Detail

MEDICARE: RANDY L TELANDER PH.D.

MEDICARE: RANDY L TELANDER PH.D.
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
1103T00000XPsychologist2006000183MO
2103TC0700XClinical Psychologist2006000183MO

General Provider Information

NPI Number : 1487691994
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDY L TELANDER PH.D.
Provider Business Mailing Address
First Line : 1302 STABLESTONE LN
Second Line :
City : COLUMBIA
State : MO
Zip : 65201-2892
Country : US
Telephone Number : 573-489-8573
Fax Number :
Provider Business Practice Location Address
First Line : 600 E 5TH ST
Second Line :
City : FULTON
State : MO
Zip : 65251-1753
Country : US
Telephone Number : 573-592-2623
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 08/25/2022

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