Provider Demographics
NPI:1437428406
Name:DEGGELMAN, ELISSA LAMPE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:LAMPE
Last Name:DEGGELMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:LOCUST BUILDING, SUITE 280
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-3701
Mailing Address - Fax:330-543-4271
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:LOCUST BUILDING, SUITE 280
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-3701
Practice Address - Fax:330-543-4271
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6883103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist