Mary Ellen Degnan, PH.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PY01517 Issued in MO

Practice address

108 E Green Meadows Rd Ste 5
Columbia, MO 65203-3633

Phone

(573) 874-5188

NPI assigned

Jan 19, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205989688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 W HIGH POINT LN",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652038942",
            "telephone_number": "573-445-2754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 E GREEN MEADOWS RD STE 5",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652033633",
            "telephone_number": "573-874-5188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGNAN",
        "first_name": "MARY",
        "middle_name": "ELLEN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MO",
            "license": "PY01517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dylan Michael Declue
• Christine Marie Deeths, M.D.
• Eliza Lamin Defroda, MD
• Steven Defroda, MD
• Shawn M Degler, MD
• Rebecca Vantil Degraaf, PHD
• Vanessa Irene Dejong
• Alda Magda Del Porto-Dahms, CRNA
• Angela Del Priore
• Patrice Delafontaine, M.D.

• Clinical Child & Adolescent Psychologist in Columbia, MO
• Providers in Columbia, MO by specialty
• Clinical Child & Adolescent Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.