Provider Demographics
NPI:1194822734
Name:WYLIE, DEBRA KAY (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:KAY
Last Name:WYLIE
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 CALAIS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9179
Mailing Address - Country:US
Mailing Address - Phone:260-625-4323
Mailing Address - Fax:260-625-3179
Practice Address - Street 1:2229 CALAIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46814-9179
Practice Address - Country:US
Practice Address - Phone:260-625-4323
Practice Address - Fax:260-625-3179
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003447A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist