Provider Demographics
NPI:1053524512
Name:DEBRA D. HORTON
Entity type:Organization
Organization Name:DEBRA D. HORTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSE, CCC-SLP
Authorized Official - Phone:870-946-8817
Mailing Address - Street 1:905 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-2903
Mailing Address - Country:US
Mailing Address - Phone:870-946-8817
Mailing Address - Fax:
Practice Address - Street 1:905 W 10TH ST
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:AR
Practice Address - Zip Code:72042-2903
Practice Address - Country:US
Practice Address - Phone:870-946-8817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP638251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120048721Medicaid