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General NPI Number Information
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NPI Number | 1376113597
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Entity Type | Individual
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Provider Name | DEBRA CHRISTIANE O'CONNELL PHD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 02/26/2022
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Provider Practice Location Address
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Address Line | 4101 S 4TH ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5014
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Country | US
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Telephone | 913-682-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 4111 BROADWAY UNIT 607
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City | KANSAS CITY
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State | MO
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Zip | 64111-3527
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Country | US
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Telephone | 818-442-1353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1051
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License Number State | NE
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