Provider Demographics
NPI:1124406046
Name:POIRIER, DEBORAH (MA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:POIRIER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:POIRIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:5411 W 142ND PL
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6631
Mailing Address - Country:US
Mailing Address - Phone:310-536-9885
Mailing Address - Fax:
Practice Address - Street 1:5411 W 142ND PL
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6631
Practice Address - Country:US
Practice Address - Phone:310-536-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist