Provider Demographics
NPI:1447429436
Name:SUMRALL, DEBORAH KAYE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:KAYE
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 W ANDREW JOHNSON HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-8585
Mailing Address - Country:US
Mailing Address - Phone:423-586-9495
Mailing Address - Fax:423-586-9549
Practice Address - Street 1:6111 W ANDREW JOHNSON HWY STE 5
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8585
Practice Address - Country:US
Practice Address - Phone:423-586-9495
Practice Address - Fax:423-586-9549
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001802235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507559Medicaid