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1255442612 NPI number — DEBORAH KATHRYN ELLIOTT-DESORBO PHD

NPI Number: 1255442612
Health Care Provider/Practitioner: DEBORAH KATHRYN ELLIOTT-DESORBO PHD

Information about “1255442612” NPI (DEBORAH KATHRYN ELLIOTT-DESORBO PHD) exists in 1255442612 in HTML format HTML  |  1255442612 in plain Text format TXT  |  1255442612 in PDF (Portable Document Format) PDF  |  1255442612 in an XML format XML  formats.

NPI Number : 1255442612 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255442612",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ELLIOTT-DESORBO",
    "FirstName": "DEBORAH",
    "MiddleName": "KATHRYN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ELLIOTT",
    "OtherFirstName": "DEBORAH",
    "OtherMiddleName": "KATHRYN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 62342",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLORADO SPRINGS",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80962-2342",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "719-332-5177",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6455 N UNION BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 103",
    "PracticeLocationAddressCityName": "COLORADO SPRINGS",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80918-5852",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "719-332-5177",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/31/2006",
    "LastUpdateDate": "06/24/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "103TC0700X",
        "TaxonomyName": "Clinical Psychologist",
        "LicenseNumber": "PSY-3210",
        "LicenseNumberStateCode": "CO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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