MEDICARE: REBECCA LINNEA ST JOHN MA

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	PY00583	MO

General Provider Information

NPI Number	:	1538191234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA LINNEA ST JOHN MA

Provider Business Mailing Address
First Line	:	2029 BUCHANAN
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116
Country	:	US
Telephone Number	:	816-474-7322
Fax Number	:	816-474-6202

Provider Business Practice Location Address
First Line	:	2029 BUCHANAN
Second Line	:
City	:	NORTH KANSAS CITY
State	:	MO
Zip	:	64116
Country	:	US
Telephone Number	:	816-474-7322
Fax Number	:	816-474-6202

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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