Provider Demographics
NPI:1275640104
Name:FOLEY, DEBRA CAROL (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:CAROL
Last Name:FOLEY
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:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:PELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53157
Mailing Address - Country:US
Mailing Address - Phone:815-823-3232
Mailing Address - Fax:
Practice Address - Street 1:1257 W LAKE SHORE DR
Practice Address - Street 2:N
Practice Address - City:PELL LAKE
Practice Address - State:WI
Practice Address - Zip Code:53157
Practice Address - Country:US
Practice Address - Phone:815-823-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632110OtherBLUE CROSS BLUE SHIELD