Provider Demographics
NPI:1093135378
Name:LAW, DEBRA (B S, MS)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:LAW
Suffix:
Gender:F
Credentials:B S, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7148 AMBERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5414
Mailing Address - Country:US
Mailing Address - Phone:909-864-2377
Mailing Address - Fax:
Practice Address - Street 1:7148 AMBERWOOD LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5414
Practice Address - Country:US
Practice Address - Phone:909-864-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 6857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist