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NPI Code Detail

MEDICARE: DR. THERESA M VAN ISEGHEM PSY.D.

MEDICARE: DR. THERESA M VAN ISEGHEM PSY.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
1103TC0700XClinical Psychologist071007872IL

General Provider Information

NPI Number : 1861716417
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THERESA M VAN ISEGHEM PSY.D.
Provider Business Mailing Address
First Line : 334 POINTE LOMA BLVD
Second Line :
City : LAKE ST LOUIS
State : MO
Zip : 63367-4301
Country : US
Telephone Number : 314-591-0093
Fax Number :
Provider Business Practice Location Address
First Line : 2727 WASHINGTON AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63103-1421
Country : US
Telephone Number : 314-534-8778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2010
Last Update Date : 04/25/2024

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