Provider Demographics
NPI:1528188349
Name:DEBLANDER, MARJORIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:DEBLANDER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:DUBOISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17702-6784
Mailing Address - Country:US
Mailing Address - Phone:570-326-6882
Mailing Address - Fax:
Practice Address - Street 1:1201 RURAL AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1669
Practice Address - Country:US
Practice Address - Phone:570-323-4340
Practice Address - Fax:570-329-3083
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001745L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist