Provider Demographics
NPI:1922009117
Name:ESCH, DEBRA (MS, LP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:ESCH
Suffix:
Gender:F
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 1ST AVE SW
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3383
Mailing Address - Country:US
Mailing Address - Phone:507-289-5110
Mailing Address - Fax:507-281-5335
Practice Address - Street 1:421 1ST AVE SW
Practice Address - Street 2:SUITE 200E
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-3383
Practice Address - Country:US
Practice Address - Phone:507-289-5110
Practice Address - Fax:507-281-5335
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3165174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN584223900Medicaid