Provider Demographics
NPI:1083083562
Name:BETTS, DEBORAH (MS)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:
Last Name:BETTS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:LEADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP, MS
Mailing Address - Street 1:7118 WILSON LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-4928
Mailing Address - Country:US
Mailing Address - Phone:301-924-3021
Mailing Address - Fax:
Practice Address - Street 1:17904 GEORGIA AVE
Practice Address - Street 2:SUITE 105A
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2239
Practice Address - Country:US
Practice Address - Phone:301-924-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD04073OtherMARYLAND LICENSE