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NPI Code Detail

MEDICARE: DR. AMY D BERTELSON PHD

MEDICARE:  DR. AMY D BERTELSON  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
1103TC0700XClinical Psychologist00935MO

General Provider Information

NPI Number : 1942226188
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY D BERTELSON PHD
Provider Business Mailing Address
First Line : 660 S EUCLID AVE
Second Line : CB 8111
City : SAINT LOUIS
State : MO
Zip : 63110-1010
Country : US
Telephone Number : 314-362-1408
Fax Number : 314-747-4342
Provider Business Practice Location Address
First Line : 1600 S BRENTWOOD BLVD
Second Line : DIV NEUROLOGY SLEEP MED, STE 600
City : SAINT LOUIS
State : MO
Zip : 63144-1320
Country : US
Telephone Number : 314-362-1408
Fax Number : 314-747-4342
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 11/15/2021

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Directions to “ DR. AMY D BERTELSON PHD” Practice Location

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