Provider Demographics
NPI:1356492862
Name:SERIO, DELORIS PURGASON (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DELORIS
Middle Name:PURGASON
Last Name:SERIO
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MS
Other - First Name:DELORIS
Other - Middle Name:LEE
Other - Last Name:PURGASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:45 REDBUD LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-5640
Mailing Address - Country:US
Mailing Address - Phone:828-456-5705
Mailing Address - Fax:828-456-5705
Practice Address - Street 1:45 REDBUD LN
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-5640
Practice Address - Country:US
Practice Address - Phone:828-456-5705
Practice Address - Fax:828-456-5705
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7424889Medicaid