Active NPI
Deborah Bushway, PH.D., LP
- Clinical Psychologist
- St Louis Park, MN
National Provider Identifier
1669694550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP1712
- Practice address
- Parkdale Plaza
1660 South Hwy 100
St Louis Park, MN 55427 - Phone
- (612) 385-2229
- NPI assigned
- May 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP1712 | MN | Primary |
Addresses
Primary practice location
Parkdale Plaza
1660 South Hwy 100
St Louis Park, MN 55427
Mailing address
7310 Ridgeway Rd
Golden Valley, MN 55427
Phone (612) 385-2229
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP1712 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187222400000",
"number": "1669694550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7310 RIDGEWAY RD",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "55427",
"telephone_number": "612-385-2229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PARKDALE PLAZA",
"address_2": "1660 SOUTH HWY 100",
"city": "ST LOUIS PARK",
"state": "MN",
"postal_code": "55427",
"telephone_number": "612-385-2229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSHWAY",
"first_name": "DEBORAH",
"name_prefix": "Dr.",
"credential": "PH.D., LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-02",
"last_updated": "2007-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP1712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.