Provider Demographics
NPI:1932325495
Name:WHITE, DEBORAH D (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:D
Last Name:WHITE
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 1:7401 METRO BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3062
Mailing Address - Country:US
Mailing Address - Phone:612-268-5858
Mailing Address - Fax:612-268-5858
Practice Address - Street 1:1550 AMERICAN BLVD E STE 550
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-3100
Practice Address - Country:US
Practice Address - Phone:612-504-2031
Practice Address - Fax:612-268-5868
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3937103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN702723100Medicaid
MN42P38WHOtherBLUE CROSS OF MN CLINIC #