Provider Demographics
NPI:1043411606
Name:VANDERHOFF, DEBORAH MARY (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MARY
Last Name:VANDERHOFF
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:MARY
Other - Last Name:REVENEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:10347 VAN BUREN BAY RD
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-9651
Mailing Address - Country:US
Mailing Address - Phone:716-679-5637
Mailing Address - Fax:
Practice Address - Street 1:10347 VAN BUREN BAY RD
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-9651
Practice Address - Country:US
Practice Address - Phone:716-679-5637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010284-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist