Linda Susan Broeckl, PH.D.
Individual provider Active NPI Clinical Psychologist · Wpafb, OH
NPI 1750375697 · NPPES record last updated Apr 14, 2015
Key facts
- NPI
- 1750375697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 4970 (OH)
- Practice address
- 4881 Sugar Maple Ave
88 Mdos/Sgow
Wpafb, OH 45433 - Phone
- (937) 257-6877
- NPI assigned
- Sep 7, 2005
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4970 | OH | Yes |
Addresses
Primary practice location
4881 Sugar Maple Ave
88 Mdos/Sgow
Wpafb, OH 45433
Mailing address
4881 Sugar Maple Ave
88 Mdos/Sgow
Wpafb, OH 45433
Phone (937) 257-6877
Other providers in Wpafb, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 14, 2015. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.