Provider Demographics
NPI:1427576230
Name:SVOBODNY, DEBBIE ANN LESLIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:ANN LESLIE
Last Name:SVOBODNY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:DEBBIE
Other - Middle Name:ANN LESLIE
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:524 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2130
Mailing Address - Country:US
Mailing Address - Phone:612-214-7450
Mailing Address - Fax:
Practice Address - Street 1:4955 17TH AVE S STE 122
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3372
Practice Address - Country:US
Practice Address - Phone:701-234-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1041C0700XMedicaid