Provider Demographics
NPI:1518392562
Name:KRICK, DEBRA (SLP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KRICK
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 1:106 ALMOND LN
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-9777
Mailing Address - Country:US
Mailing Address - Phone:217-525-1880
Mailing Address - Fax:217-528-9318
Practice Address - Street 1:555 W CARPENTER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4905
Practice Address - Country:US
Practice Address - Phone:217-525-1880
Practice Address - Fax:217-528-9318
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.003911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist