Provider Demographics
NPI:1194464313
Name:NOVEMBER, DEBORAH A (SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:NOVEMBER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BOY SCOUT DR
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-1416
Mailing Address - Country:US
Mailing Address - Phone:401-864-5725
Mailing Address - Fax:
Practice Address - Street 1:25 W INDEPENDENCE WAY STE I
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1127
Practice Address - Country:US
Practice Address - Phone:401-874-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP00360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty