Healthcare Provider Details

I. General information

NPI: 1285607366
Provider Name (Legal Business Name): DEBORAH LYNN GEGG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH GREEN

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7919 BIG BEND BLVD STE B
WEBSTER GROVES MO
63119-2703
US

IV. Provider business mailing address

11 ANGEST LANE
WEBSTER GROVES MO
63119
US

V. Phone/Fax

Practice location:
  • Phone: 314-566-4247
  • Fax:
Mailing address:
  • Phone: 314-566-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number005540
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: