Provider Demographics
NPI:1396815270
Name:BELL, DEBORAH (MACCC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:MACCC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:BELL
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MACCC
Mailing Address - Street 1:326 ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060
Mailing Address - Country:US
Mailing Address - Phone:831-425-8840
Mailing Address - Fax:831-469-4707
Practice Address - Street 1:326 ALTA AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-6442
Practice Address - Country:US
Practice Address - Phone:831-425-8840
Practice Address - Fax:831-469-4707
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP0034560Medicaid
BY677ZMedicare PIN