Provider Demographics
NPI:1477620565
Name:LATHAM, DEANA ELIZABETH (AUD)
Entity Type:Individual
Prefix:DR
First Name:DEANA
Middle Name:ELIZABETH
Last Name:LATHAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2040
Mailing Address - Country:US
Mailing Address - Phone:334-793-2211
Mailing Address - Fax:334-702-1296
Practice Address - Street 1:2800 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2040
Practice Address - Country:US
Practice Address - Phone:334-793-2211
Practice Address - Fax:334-701-1296
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1367231H00000X
AL1041A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist