Healthcare Provider Details

I. General information

NPI: 1497083000
Provider Name (Legal Business Name): DEBRA ELIZABETH STUMVOLL M.A., L. P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 STEARNS WAY SUITE 111
SAINT CLOUD MN
56303-4491
US

IV. Provider business mailing address

32351 91ST AVE
SAINT JOSEPH MN
56374-9673
US

V. Phone/Fax

Practice location:
  • Phone: 320-253-3540
  • Fax: 320-253-1475
Mailing address:
  • Phone: 320-363-4902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP5170
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: