Provider Demographics
NPI:1093232191
Name:PREISSER, DEBRA ANN (PHD, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:PREISSER
Suffix:
Gender:F
Credentials:PHD, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MINER ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60928-8092
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2561 E US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:DONOVAN
Practice Address - State:IL
Practice Address - Zip Code:60931-8060
Practice Address - Country:US
Practice Address - Phone:815-486-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist