Provider Demographics
NPI:1508196452
Name:KATZ, DEBRA R (MA, CCC-SP/L)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:R
Last Name:KATZ
Suffix:
Gender:F
Credentials:MA, CCC-SP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4362
Mailing Address - Country:US
Mailing Address - Phone:847-254-4316
Mailing Address - Fax:847-831-4760
Practice Address - Street 1:603 RIDGE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4362
Practice Address - Country:US
Practice Address - Phone:847-254-4316
Practice Address - Fax:847-831-4760
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist