Deborah Jean Clemmensen, M.EQ.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

LP2635 Issued in MN

Practice address

10520 Wayzata Blvd
Woodside Office Park
Minnetonka, MN 55305-1511

Phone

(952) 767-0190

Fax

(952) 544-3401

NPI assigned

Jul 31, 2006

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

State licenses

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1992711154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3525 IRVING AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554083325",
            "telephone_number": "612-827-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10520 WAYZATA BLVD",
            "address_2": "WOODSIDE OFFICE PARK",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051511",
            "telephone_number": "952-767-0190",
            "fax_number": "952-544-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMMENSEN",
        "first_name": "DEBORAH",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "M.EQ.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP2635",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Allen Clark, MD
• Jazmin Clausen-Thomas
• Kendall Marie Clausen
• Monica Clayton
• Darla Cleary, MA, LPCC
• Meghan Clifford, PSYD
• Clinsura, Inc
• Katy Marie Cloutier, MA,CCC,SLP
• Ayanna Tyne Clowers, NP-C
• Joel C Cobb, APRN

• Clinical Child & Adolescent Psychologist in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Clinical Child & Adolescent Psychologist in Minnesota

• 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.