Debra Ann Stack in Minneapolis - Clinical Child & Adolescent
Debra Ann Stack - NPI 1740376268
Debra Ann Stack is a Clinical Child & Adolescent in Minneapolis, Minnesota. Debra Ann Stack practices all healthcare services and medical treatments related to Clinical Child & Adolescent. The NPI Number for Debra Ann Stack is 1740376268. The last update date is 2007-07-09.
Debra Ann Stack's current location address is 2124 Dupont Avenue South #104, Minneapolis, Minnesota. You can contact this provider via phone number 6124811140 and fax number 6128790059. The mailing address for Debra Ann Stack is 2124 Dupont Avenue South #104, Minneapolis, Minnesota. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Debra Ann Stack |
|---|---|
| Address | 2124 Dupont Avenue South #104, Minneapolis, Minnesota |
| Phone Number | 6124811140 |
| Fax Number | 6128790059 |
| Sole Proprietor | Y |
| Credentials | M.A.,L.P. |
NPI Number Detail
| NPI Number | 1740376268 |
|---|---|
| Provider Enumeration Date | 2006-10-04 |
| Last Updated Date | 2007-07-09 |
Provider Mailing Address Detail
| Address | 2124 Dupont Avenue South #104 |
|---|---|
| City | Minneapolis |
| State | Minnesota (MN) |
| Post Code | 55403 |
| Phone Number | 6124811140 |
| Fax Number | 6128790059 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical Child & Adolescent |
|---|---|
| Taxonomy | 103Tc2200X |
| Licence No | LP3157 |
|
Definition: A psychologist who develops and applies scientific knowledge to the delivery of psychological services to infants, toddlers, children and adolescents within their social context. Of particular importance to the specialty of clinical child psychology |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| ON FILE | MN | BEHAVIORAL HEALTHCARE PRO | |
| ON FILE | FM | UCARE | |
| ON FILE | MN | PREFERRED ONE | |
| ON FILE | FM | BLUE CROSS BLUE SHIELD | |
| ON FILE | MN | PFIZER HC | |
| ON FILE | MN | UBH | |
| ON FILE | MN | AETNA | |
| ON FILE | MN | -- |
Post Comment/ Review Below
What is the unique identification code assigned to Debra Ann Stack by the Centers for Medicare & Medicaid Services?
The Debra Ann Stack has been issued the NPI (National Provider Identifier) 1740376268. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you share the physical location details of Debra Ann Stack?
The Debra Ann Stack is situated at 2124 Dupont Avenue South #104, in the city of Minneapolis, state of MN, with the zip code 55403.
What is the area of specialization for Debra Ann Stack, and what is the corresponding taxonomy classification code for this field?
The specialized field of practice for Debra Ann Stack is Clinical Child & Adolescent, and the corresponding taxonomy code that categorizes this area of expertise is 103Tc2200X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1740376268 to Debra Ann Stack?
The Centers for Medicare & Medicaid Services originally issued the 1740376268 to Debra Ann Stack on 2006-10-04.
As of what date were the Debra Ann Stack's details last updated?
The information pertaining to the Debra Ann Stack, including its address, specialty, and other details, was most recently updated on 2007-07-09.
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