MEDICARE: YASUKO YAMAMOTO LANDRUM 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
1	103TC0700X	Clinical Psychologist	1805	KS

General Provider Information

NPI Number	:	1851489678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASUKO YAMAMOTO LANDRUM PHD

Provider Business Mailing Address
First Line	:	6541 SPECKER AVE
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4263
Country	:	US
Telephone Number	:	719-503-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	6541 SPECKER AVE
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4263
Country	:	US
Telephone Number	:	719-503-7070
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	02/03/2021

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