Provider Demographics
NPI:1124534656
Name:CANTRELL, DEBRA DARLENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:DARLENE
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W END AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448-1828
Mailing Address - Country:US
Mailing Address - Phone:618-783-2525
Mailing Address - Fax:
Practice Address - Street 1:101 MAXWELL ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1661
Practice Address - Country:US
Practice Address - Phone:618-783-8464
Practice Address - Fax:618-783-4106
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01114039OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION