Provider Demographics
NPI:1497083000
Name:STUMVOLL, DEBRA ELIZABETH (MA, L P)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ELIZABETH
Last Name:STUMVOLL
Suffix:
Gender:F
Credentials:MA, L P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32351 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MN
Mailing Address - Zip Code:56374-9673
Mailing Address - Country:US
Mailing Address - Phone:320-363-4902
Mailing Address - Fax:
Practice Address - Street 1:2025 STEARNS WAY
Practice Address - Street 2:SUITE 111
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4491
Practice Address - Country:US
Practice Address - Phone:320-253-3540
Practice Address - Fax:320-253-1475
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5170103T00000X
103TB0200X, 103TC1900X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily