MS. DEBRA ANN STACK (NPI# 1740376268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740376268 |
| Entity Type | Individual |
| Full Name | MS. DEBRA ANN STACK |
| Credential | M.A.,L.P. |
| Practice Address |
2124 Dupont Avenue South #104 Minneapolis MN 55403 |
| Practice Telephone | 6124811140 |
| Practice Fax Number | 6128790059 |
| Mailing Telephone | 6124811140 |
| Mailing Fax Number | 6128790059 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 103TB0200X |
Psychologist Specialization: Cognitive & Behavioral |
LP 3157 | MN | Behavioral Health & Social Service Providers |
| X | 103TC0700X |
Psychologist Specialization: Clinical |
LP3157 | MN | Behavioral Health & Social Service Providers |
| X | 103TC1900X |
Psychologist Specialization: Counseling |
LP 3157 | MN | Behavioral Health & Social Service Providers |
| X | 103TC2200X |
Psychologist Specialization: Clinical Child & Adolescent |
LP3157 | MN | Behavioral Health & Social Service Providers |
| X | 103TF0000X |
Psychologist Specialization: Family |
LP 3157 | MN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | PREFERRED ONE | ON FILE | 01 |
| MN | PFIZER HC | ON FILE | 01 |
| MN | UBH | ON FILE | 01 |
| MN | BEHAVIORAL HEALTHCARE PRO | ON FILE | 01 |
| MN | ON FILE | 05 | |
| MN | AETNA | ON FILE | 01 |
| FM | BLUE CROSS BLUE SHIELD | ON FILE | 01 |
| FM | UCARE | ON FILE | 01 |
| Street Address |
2124 DUPONT AVENUE SOUTH #104 |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55403 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508312174 | Afya Translation Corp | Interpreter | 1 E 19th Street, Suite 2, Minneapolis, MN 55403 | 2016-09-01 |
| 1891146692 | Alicia Kornacker | Doula | 1937 Aldrich Avenue South, Apt 12, Minneapolis, MN 55403 | 2016-06-23 |
| 1437506417 | Zahra Roble | Nurse Practitioner | 1801 Nicolllet Ave S, Minneapolis, MN 55403 | 2016-05-19 |
| 1063871259 | Vicky Smiley-turner | Counselor | 1523 Nicollet Ave. South, Minneapolis, MN 55403 | 2016-02-16 |
| 1326449026 | Lowry Hill Psychotherapy and Assessment Center | Psychologist | 1910 Hennepin Ave S, Minneapolis, MN 55403 | 2014-09-12 |
| 1285062372 | Cheryl Patterson | Marriage & Family Therapist | 1725 2nd Ave So, Minneapolis, MN 55403 | 2013-10-29 |
| 1598101156 | Sherri M Dunham | Counselor | 1200 S Marquette Ave, Minneapolis, MN 55403 | 2013-05-21 |
| 1831533173 | Laura Farley Young | Social Worker | 1925 Nicollet Ave S, Minneapolis, MN 55403 | 2013-04-17 |
| 1275801797 | Elizabeth Ann Hamer | Counselor | 1717/1725 2nd Ave. So., Minneapolis, MN 55403 | 2011-12-12 |
| 1679859185 | Accord Medical Inc | Durable Medical Equipment & Medical Supplies | 1815 Nicollet Ave, Minneapolis, MN 55403 | 2011-10-27 |
| Find all providers in zip 55403 | ||||
| Taxonomy Code | 103TB0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Cognitive & Behavioral |
| Definition to come... |
| Notes: [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801208566 | Rose Mary Boerboom | Psychologist | 415 N 1st St, #502, Minneapolis, MN 55401-4305 | 2014-05-28 |
| 1073826913 | Scott Michael Jacoby | Psychologist | 2110 Lyndale Ave S, Minneapolis, MN 55405-3196 | 2010-07-20 |
| 1174686216 | Susan A Medo | Psychologist | 100 W Franklin Ave, Minneapolis, MN 55404-2433 | 2006-12-19 |
| 1447338702 | Eric Larsson | Psychologist | 2925 Dean Pkwy, Suite 300, Minneapolis, MN 55416-4470 | 2006-11-02 |
| 1417035551 | Jennifer Lynn Joseph | Psychologist | 3001 Broadway St Ne, Suite 185, Minneapolis, MN 55413-2195 | 2006-11-02 |
| 1942380316 | Janice L Ostrom | Psychologist | 4535 Washburn Ave N, Minneapolis, MN 55412-1055 | 2006-10-17 |
| 1194093641 | Kavita Mahesh Desai | Psychologist | 2545 Chicago Ave S, Suite 306, Mail Stop 17-306, Minneapolis, MN 55404-4543 | 2011-12-12 |
| 1649411406 | Meredith L. Gunlicks-stoessel | Psychologist | 2450 Riverside Ave, F256/2b West, Department of Psychiatry, Minneapolis, MN 55454-1450 | 2009-03-09 |
| 1114083540 | Brih Design LLC | Psychologist | 4535 Washburn Ave N, Minneapolis, MN 55412-1055 | 2006-12-29 |
| 1003987983 | Murray Joseph Mcallister | Psychologist | 800 E 28th St, Minneapolis, MN 55407-3723 | 2006-11-13 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55403 |
Please comment or provide details below to improve the information on MS. DEBRA ANN STACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.