Provider Demographics
NPI:1356318729
Name:RETTSTATT, LINDA K (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:RETTSTATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 LENOX PARK BLVD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-4260
Mailing Address - Country:US
Mailing Address - Phone:901-273-2368
Mailing Address - Fax:901-273-2351
Practice Address - Street 1:3175 LENOX PARK BLVD
Practice Address - Street 2:SUITE 412
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4260
Practice Address - Country:US
Practice Address - Phone:901-273-2368
Practice Address - Fax:901-273-2351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000046521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3987207Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO