Healthcare Provider Details

I. General information

NPI: 1942497680
Provider Name (Legal Business Name): DEBRA OVERLEE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35382 US HIGHWAY 2
GRAND RAPIDS MN
55744-4754
US

IV. Provider business mailing address

35382 US HIGHWAY 2
GRAND RAPIDS MN
55744-4754
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-4886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: