Provider Demographics
NPI:1831228519
Name:PERRY, DEBORAH KAY (LICSW)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KAY
Last Name:PERRY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-0074
Mailing Address - Country:US
Mailing Address - Phone:952-855-8801
Mailing Address - Fax:847-474-4426
Practice Address - Street 1:1600 ARBORETUM BLVD STE 103
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-4303
Practice Address - Country:US
Practice Address - Phone:952-855-8801
Practice Address - Fax:847-474-4426
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8619-1231041C0700X
MN154481041C0700X
IL149.0110871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
IL$$$$$$$$$001Medicaid
WIK40227Medicare UPIN