Provider Demographics
NPI:1851725634
Name:SIDHU, LINDA (RSAP-P)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SIDHU
Suffix:
Gender:F
Credentials:RSAP-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 E BATTLEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4802
Mailing Address - Country:US
Mailing Address - Phone:417-865-8045
Mailing Address - Fax:
Practice Address - Street 1:404 E BATTLEFIELD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4802
Practice Address - Country:US
Practice Address - Phone:417-865-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO7518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)