MEDICARE: ROXANNE LOUH 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
1	103T00000X	Psychologist	PY7400	FL

General Provider Information

NPI Number	:	1912924812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNE LOUH PH.D.

Provider Business Mailing Address
First Line	:	3527 HENDRICKS AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5309
Country	:	US
Telephone Number	:	904-318-9418
Fax Number	:	904-399-1547

Provider Business Practice Location Address
First Line	:	3527 HENDRICKS AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5309
Country	:	US
Telephone Number	:	904-318-9418
Fax Number	:	904-399-1547

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	05/31/2016

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