Healthcare Provider Details

I. General information

NPI: 1326133927
Provider Name (Legal Business Name): DEANNA S PLEDGE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/24/2024
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E. BROADWAY
COLUMBIA MO
65201
US

IV. Provider business mailing address

1527 SAINT MICHAEL DRIVE
COLUMBIA MO
65203
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-2020
  • Fax:
Mailing address:
  • Phone: 573-815-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY1868
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number01868
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY1868
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: