Provider Demographics
NPI:1326282492
Name:FREDERICK, DEBORAH L (SLP- CCC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:L
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:SLP- CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 FREDERICK DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-3245
Mailing Address - Country:US
Mailing Address - Phone:518-493-6020
Mailing Address - Fax:
Practice Address - Street 1:427 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1707
Practice Address - Country:US
Practice Address - Phone:518-561-3803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019026-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist