Provider Demographics
NPI:1487858619
Name:DELONG, DEBORAH TAYLOR (SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:TAYLOR
Last Name:DELONG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2588 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-1109
Mailing Address - Country:US
Mailing Address - Phone:559-897-2276
Mailing Address - Fax:559-869-6075
Practice Address - Street 1:1118 N CHINOWTH ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-7896
Practice Address - Country:US
Practice Address - Phone:559-741-9687
Practice Address - Fax:559-741-9694
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10271235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10271OtherSTATE LICENSE