Provider Demographics
NPI:1598980153
Name:KROLL, DEBORAH SUSAN (PHD, EDS, LP)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SUSAN
Last Name:KROLL
Suffix:
Gender:F
Credentials:PHD, EDS, LP
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:KROLL-MENSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:17615 LACEY DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8207
Mailing Address - Country:US
Mailing Address - Phone:907-696-3119
Mailing Address - Fax:
Practice Address - Street 1:17615 LACEY DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8207
Practice Address - Country:US
Practice Address - Phone:907-696-3119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK 552103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent