Provider Demographics
NPI:1437203221
Name:VANCE, DEBORAH M (CCC,SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:M
Last Name:VANCE
Suffix:
Gender:F
Credentials:CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 ROSEMONT DR
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:NC
Mailing Address - Zip Code:27235-9638
Mailing Address - Country:US
Mailing Address - Phone:336-688-2591
Mailing Address - Fax:
Practice Address - Street 1:3816 N ELM ST STE E
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2776
Practice Address - Country:US
Practice Address - Phone:336-370-4070
Practice Address - Fax:336-370-9008
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC406235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC137KFOtherBCBS INDIV.PROVIDER#
NC013X1OtherBCBS GROUP PROV. #
NC7411224Medicaid
NC7211258OtherMEDICAID GROUP PROV. #