Provider Demographics
NPI:1053620658
Name:SALOMON, DEBRA (MACCCSLP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:SALOMON
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 HOLIDAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2542
Mailing Address - Country:US
Mailing Address - Phone:516-783-7868
Mailing Address - Fax:
Practice Address - Street 1:1415 HOLIDAY PARK DR
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2542
Practice Address - Country:US
Practice Address - Phone:516-783-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008485-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist