Provider Demographics
NPI:1952706095
Name:KERR, DEBORAH LUCILLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LUCILLE
Last Name:KERR
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 1:2214 EARLEEN ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1812
Mailing Address - Country:US
Mailing Address - Phone:573-271-2008
Mailing Address - Fax:573-271-2008
Practice Address - Street 1:1223 N KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-3506
Practice Address - Country:US
Practice Address - Phone:573-271-2008
Practice Address - Fax:573-271-2008
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1800390200000X
MO2019011187103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program