Provider Demographics
NPI:1134107097
Name:FROST, DEBORAH R (PHD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:FROST
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:C
Other - Last Name:RETTIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10600 FAWN RDG
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-7592
Mailing Address - Country:US
Mailing Address - Phone:573-578-2962
Mailing Address - Fax:
Practice Address - Street 1:1450 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3648
Practice Address - Country:US
Practice Address - Phone:573-364-7551
Practice Address - Fax:573-364-4898
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002021883103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495937807Medicaid
MO495937807Medicaid