Provider Demographics
NPI:1134264237
Name:LINDBERG, FREDERICK H (PHD)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:H
Last Name:LINDBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 CHUCKWAGON TRL
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-9123
Mailing Address - Country:US
Mailing Address - Phone:307-237-9093
Mailing Address - Fax:
Practice Address - Street 1:136 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2739
Practice Address - Country:US
Practice Address - Phone:307-259-8773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY68103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical