Provider Demographics
NPI:1609836329
Name:BJORK, DEBRA F (PHD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:F
Last Name:BJORK
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 1:300 BOARDWALK DR
Mailing Address - Street 2:UNIT 5A
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3070
Mailing Address - Country:US
Mailing Address - Phone:970-223-2256
Mailing Address - Fax:970-223-2324
Practice Address - Street 1:300 BOARDWALK DR
Practice Address - Street 2:UNIT 5A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3070
Practice Address - Country:US
Practice Address - Phone:970-223-2256
Practice Address - Fax:970-223-2324
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1566103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65446Medicare UPIN