Provider Demographics
NPI:1346580271
Name:MOON, DEBORAH JEAN (SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:MOON
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 1:1560 E 21ST ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1351
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1560 E 21ST ST
Practice Address - Street 2:SUITE 210
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1351
Practice Address - Country:US
Practice Address - Phone:918-949-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist