Provider Demographics
NPI:1366646721
Name:REYNOLDS, DEBORAH (MA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12717 DEER PATH DR
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18302-8643
Mailing Address - Country:US
Mailing Address - Phone:917-604-8319
Mailing Address - Fax:
Practice Address - Street 1:12717 DEER PATH DR
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18302-8643
Practice Address - Country:US
Practice Address - Phone:917-604-8319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017884235Z00000X
PASL009106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist