Provider Demographics
NPI:1518244151
Name:GERDES, DEBORAH LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LYNN
Last Name:GERDES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:LYNN
Other - Last Name:SERBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3700 W KILGORE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-4810
Mailing Address - Country:US
Mailing Address - Phone:765-289-5437
Mailing Address - Fax:
Practice Address - Street 1:13819 HANSON BLVD NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304
Practice Address - Country:US
Practice Address - Phone:612-672-6999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01422101YM0800X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor