Janine B. Brodeur, PHD
Individual provider Active NPI Clinical Psychologist · Saint Louis, MO
NPI 1396867073 · NPPES record last updated Jun 18, 2019
Key facts
- NPI
- 1396867073
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 1999140465 (MO)
- Practice address
- 7396 Pershing Ave
Saint Louis, MO 63130-4206 - Phone
- (314) 333-9474
- NPI assigned
- Apr 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
34 N Brentwood Blvd
Saint Louis, MO 63105-3995
Phone (314) 333-9474
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191017000784 | MO | Practitioner - Clinical Psychologist | 1951632298 | Practice locations: Saint Louis, MO |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 065986 | MO | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sue Gouaux LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 065986 | MO | |
| Clinical Psychologist | 103TC0700X | 1999140465 | MO | Yes |
Addresses
Primary practice location
7396 Pershing Ave
Saint Louis, MO 63130-4206
Mailing address
417 Mission Court
St Louis, MO 63130-4018
Phone (314) 726-3487
Other practice location 1
225 S Meramec Ave
Suite 321T
Saint Louis, MO 63105-3511
Phone (314) 591-7769
Other names
- Janine Marie Bauman
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.