Provider Demographics
NPI:1053363069
Name:POWELL, DEBORAH ANN (SPT)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:POWELL
Suffix:
Gender:F
Credentials:SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 E. NICKLEBACK ST.
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85243-7901
Mailing Address - Country:US
Mailing Address - Phone:480-777-5944
Mailing Address - Fax:
Practice Address - Street 1:3341 E QUEEN CREEK RD
Practice Address - Street 2:# 109
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8503
Practice Address - Country:US
Practice Address - Phone:480-621-8361
Practice Address - Fax:480-621-8513
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist