Provider Demographics
NPI:1578687794
Name:DEBORD, RALENE STEPHANIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RALENE
Middle Name:STEPHANIE
Last Name:DEBORD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:RALENE
Other - Middle Name:S
Other - Last Name:MEHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:412 WYNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8876
Mailing Address - Country:US
Mailing Address - Phone:724-799-8080
Mailing Address - Fax:
Practice Address - Street 1:9850 OLD PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9311
Practice Address - Country:US
Practice Address - Phone:412-366-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004009L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist