Provider Demographics
NPI:1326136656
Name:PITCHER, DEBORAH S (AUD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:S
Last Name:PITCHER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 EASTLAND DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701
Mailing Address - Country:US
Mailing Address - Phone:309-662-8346
Mailing Address - Fax:309-662-0479
Practice Address - Street 1:1404 EASTLAND DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-662-8346
Practice Address - Fax:309-662-0479
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000437231H00000X
IL147-000437237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL640001788OtherRAILROAD MEDICARE
IL147000437OtherLICENSE
IL640001788OtherRAILROAD MEDICARE